- Email: [email protected]
Liver metastases from lung cancer: is surgical resection justified?
Ann Thorac Surg 2003;76:291–3
releasing hormone analog (GnRH-analog) therapy. She is currently symptom-free after 14 months of follow-up.
CASE REPORT DI CARLO ET AL RESECTED LIVER METASTASES FROM LUNG CANCER
291
6. Rock JA, Markham SM. Pathogenesis of endometriosis. Lancet 1992;340:1264 –7.
Comment
We thank Shunji Kawamura, MD, for pathologic support.
References 1. Lillington GA, Mitchell SP, Wood GA. Catamenial pneumothorax. JAMA 1972;219:1328 –32. 2. Van Schil PE, Vercauteren SR, Vermeire PA, Nackaerts YH, Van Marck EA. Catamenial pneumothorax caused by thoracic endometriosis. Ann Thorac Surg 1996;62:585–6. 3. Cowl CT, Dunn WF, Deschamps C. Visualization of diaphragmatic fenestration associated with catamenial pneumothorax. Ann Thorac Surg 1999;68:1413–4. 4. Blanco S, Hernando F, Go´ mez A, Gonza´ lez MJ, Torres AJ, Balibrea JL. Catamenial pneumothorax caused by diaphragmatic endometriosis. J Thorac Cardiovasc Surg 1998;116:179 – 80. 5. Flieder DB, Moran CA, Travis WD, Koss MN, Mark EJ. Pleuro-pulmonary endometriosis and pulmonary ectopic deciduosis: a clinicopathologic and immunohistochemical study of 10 cases with emphasis on diagnostic pitfalls. Hum Pathol 1998;29:1495–503. © 2003 by The Society of Thoracic Surgeons Published by Elsevier Inc
Liver Metastases From Lung Cancer: Is Surgical Resection Justified? Isidoro Di Carlo, MD, PhD, Giuseppe Grasso, MD, Domenico Patane’, MD, Domenico Russello, MD, and Ferdinando Latteri, MD Department of Surgical Sciences, Organs Transplantation and Advanced Technologies, University of Catania, and Departments of Pathology and Radiology, Cannizzaro Hospital, Catania, Italy
Resection of the liver for metastatic lesions has largely been done for secondary colorectal or neuroendocrine tumors, and there is little information of its value for other lesions. Recent improvements in hepatic surgery have made resection of metastases a safe procedure and it should certainly be considered whenever there is an isolated lesion. We report the case of a successful resection of an isolated secondary hepatic lesion from a lung primary tumor, which was resected approximately 4 years beforehand. A review of the literature demonstrates that although early reports of similar procedures were not favorable, more recent reports reinforce the value of an aggressive approach in favorable cases. (Ann Thorac Surg 2003;76:291–3) © 2003 by The Society of Thoracic Surgeons
L
iver resections for metastases are commonly performed for colorectal primary tumors and are poorly documented for noncolorectal tumors. Several authors suggest that liver resection of noncolorectal secondaries, unless from Wilms tumor, should be discouraged [1], whereas others take the view that selected patients are candidates for hepatic resection [2]. Few cases of resected liver metastases from lung cancer are present in the literature. The aim of this study is to report a patient operated on for isolated liver metastasis from lung cancer and review the literature. A 69-year-old woman had a lobectomy for an adenocarcinoma of the lung in June 1995, which staged well. Four years later at routine follow-up, she was found to have a 5-cm lesion in the liver located in segment VII (Fig 1). The patient remained in good health and neither a gastroscopy or colonoscopy showed evidence of an occult primary. Total body scintigraphy demonstrated no other
Accepted for publication Dec 23, 2002. Address reprint requests to Prof Di Carlo, Department of Surgical Sciences, Organs Transplantation and Advanced Technologies, University of Catania, Cannizzaro Hospital, Via Messina, Catania 95126, Italy; e-mail: [email protected].
0003-4975/03/$30.00 PII S0003-4975(03)00149-8
CASE REPORTS
Four theories for the pathogenesis of CP have been proposed: (1) loss of cervical mucus during the menstrual phase, allowing movement of air into the peritoneum, then the air traverses through the diaphragmatic fenestrations into the pleural space [1– 4]; (2) spontaneous rupture of bullae or blebs during hormonal changes [2]; (3) elevated levels of prostaglandin in the serum during menstruation, which could cause severe vascular and bronchoalveolar constriction, producing alveolar rupture [2, 4]; and (4) ectopic endometrial tissue in the visceral pleura and its desquamation during menstruation [4, 5]. Given that our patient had previously had a hysterectomy, it is unlikely that the CP was caused by movement of air through the cervix. In our patient, no blebs or bullae were found after careful thoracoscopic inspection of the lung. Thus, our report supports the theory that CP is caused by endometrial implants, which could have traveled across diaphragmatic fenestrations or lymphatic channels to reach the visceral pleura [2, 3]. A common theory regarding the cause of endometriosis is that viable endometrial cells can reflux through the fallopian tubes during menstruation, implant, and grow on the surrounding pelvic structures and peritoneum [6]. These cells could implant in the visceral pleura through the fenestrations in the diaphragm; however, pathologically confirmed endometriosis in the visceral pleura is extremely rare in the literature [5]. Our case confirms that visceral pleural endometriosis can be a cause for CP. Previous case reports of recurrent CP after diaphragmatic resection could theoretically be due to visceral endometrial implants. Therefore, careful inspection of the entire lung surface at the time of operation for CP is mandatory and systemic therapy with GnRH-analogs [2, 4], pleurodesis, or both should be considered on the treatment for CP.
292
CASE REPORT DI CARLO ET AL RESECTED LIVER METASTASES FROM LUNG CANCER
Ann Thorac Surg 2003;76:291–3
Fig 1. Computed tomographic scan showing isolated liver metastasis from the lung, located at segment VII.
CASE REPORTS
metastatic lesions. Serum markers including ␣-fetoprotein and carcino-embryogenic antigen were normal, and in view of the patient’s good health and the long period of time from the original operation, surgical resection was advised. At operation no other lesions were demonstrated and a limited resection was performed without difficulty. The postoperative course was uneventful, and the patient was discharged 5 days later. Pathologic examination of the lesion confirmed a metastatic adenocarcinoma of the lung (Fig 2). The patient had now been followed-up for 3 years with no evidence of any recurrence or other problem.
Comment Resection of metastases in the liver from a colorectal primary is now well established and has been shown to improve survival. Favorable factors are the single metastasis, rather than the multiple metastases; the grading and staging of the primary tumor; and the length of time between removal of the primary tumor and appearance of the metastases, with greater length of time being more favorable [3, 4]. Surgery for secondary metastases in the liver is also
Fig 2. Liver metastasis showing focal glandular differentiation.
accepted for neuroendocrine, testicular, and renal primaries and has been reported in certain sarcomas, breast, and gynecological cancer and melanoma[5]. However, there have not been many reports of resection after treatment of a bronchogenic carcinoma, although generally this is one of the most common cancers [6]. We have reviewed the literature and found 12 reports of metastases from the lung, frequently combined with some other rare metastases from different origins. Unfortunately several of the reports really give insufficient information for adequate analysis (Table 1). However, it is clear that reports published before 1988 did not consider that resection of metastases was worthwhile [7, 8]. More recent reports have been more favorable and this probably reflects the improvements in liver surgery that have since taken place. Although we appreciate that the situation of our patient is unusual for bronchogenic carcinoma, the fact that nonsmall cell carcinoma of the lung is relatively resistant to cytotoxic chemotherapy makes surgery worthwhile. We were naturally suspicious that the lesion in the liver may well have been a metastasis from an occult abdominal primary tumor, but extensive investigation failed to reveal any indication of this. As yet, we do not have access to positron emission tomography, but reports in the literature suggest that this modality will be helpful
Table 1. Main Characteristics of Patients Operated On for Liver Metastases From Lung Cancer Reported in the Literature Authors (reference) Berney et al [4] Cobourn et al [7] Foster et al [8] Hamy et al [6] Lindell et al [2] Schwartz [5] Stehlin et al [1] Tomas-de la Vega et al [3] Personal report
Number of Cases
Pathology of the Primitive Tumor
Type of Hepatic Resection
Survival (mo)
3 1 2 1 1 2 1 1 1
No showed No showed No showed Epidermoid tumor Bronchial carcinoma No showed No showed No showed Adenocarcinoma
No showed No showed No showed Minor resection No showed No showed Major resection No showed Minor resection
No showed No showed No showed 13 185 ⬎60 9 No showed 36
Ann Thorac Surg 2003;76:293–5
CASE REPORT SHUNSUKE ET AL MALT LYMPHOMA IN THE THYMUS
293
in similar cases in ruling out occult primaries or other unexpected secondary lesions.
References
Mucosa-Associated Lymphoid Tissue Lymphoma of the Thymus Resected Using Combined Thoracoscopic and Transcervical Approaches Shunsuke Yamada, MD, Kohno Tadasu, MD, Mun Mingyon, MD, Abe Yoshiaki, MD, and Motoi Noriko, MD Departments of Thoracic Surgery and Pathology, Toranomon Hospital, Toranomon Hospital, Tokyo, Japan
Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade variant of B cell lymphoma that arises in extranodal tissue of the gastrointestinal tract, lung, salivary gland, thyroid, or other organ derived from the foregut. However, MALT lymphoma in the thymus is extremely rare. We report a case of thymic MALT lymphoma, extending to the neck, resected using combined thoracoscopic and transcervical approaches. To the best of our knowledge, thoracoscopic management of MALT lymphoma in the thymus has not previous been reported. (Ann Thorac Surg 2003;76:293–5) © 2003 by The Society of Thoracic Surgeons
Accepted for publication Nov 25, 2002. Address reprint requests to Dr Yamada, Tokai University Hachioji Hospital, 1838 Isikawa Hachioji, Tokyo 192-0032, Japan; e-mail: yamada. [email protected].
© 2003 by The Society of Thoracic Surgeons Published by Elsevier Inc
Fig 1. Computed tomography reveals an anterior and superior mediastinal mass with solid and cystic portions.
M
ucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade variant of B cell lymphoma that arises in extranodal tissue of the gastrointestinal tract, lung, salivary gland, thyroid, or other organ derived from the foregut. Mucosa-associated lymphoid tissue lymphoma tends to grow locally, remain clinically indolent, and respond well to surgery [1]. Mucosa-associated lymphoid tissue lymphoma of the thymus, which is extremely rare, has been excised through median sternotomy or thoracotomy in all previously reported cases [1– 6]. We report a case of thymic MALT lymphoma resected by video-assisted thoracoscopic surgery (VATS) combined with a transcervical approach. A 46-year-old woman with Sjo¨ gren’s syndrome was found to have a large anterior and superior mediastinal tumor by an annual radiographic examination of the chest. Her only symptom was a dry eye, and no lymph nodes were palpable. Computed tomography (CT) of the chest revealed a follicular cystic tumor in the anterior and superior mediastinum, extending to the lower end of the thyroid gland, without lymph node enlargement (Fig 1). All laboratory tests were normal. For access to the cervical and mediastinal aspects of the tumor, we planned to combine transcervical and videoassisted thoracoscopic surgery (VATS) approaches under single-lung ventilation anesthesia. We placed the patient in a 10° semileft-lateral position with her neck extended. A 3-cm-long transverse incision above the sternal notch exposed the cervical end of an encapsulated tumor, with no involvement of surrounding tissues. After mobilizing the upper part of the tumor using electrical cautery and finger dissection, we performed a videoscopic approach with three flexible thoracoports (7-, 10-, and 10-mm diameter) in the right chest. The chest mass was a grayish, encapsulated, multicystic tumor occupying the anterior and superior mediastinum, without involvement of pulmonary tissues. Tumor dissection proceeded cephalad, and from right to left. Two thymic vessels were clipped and divided, and the tumor was completely 0003-4975/03/$30.00 PII S0003-4975(02)04965-2
CASE REPORTS
1. Stehlin JS Jr, De Ipolyi PD, Greeff PJ, et al. Treatment of cancer of the liver. Twenty years’ experience with infusion and resection in 414 patients. Ann Surg 1988;208:23–35. 2. Lindell G, Ohlsson B, Saarela A, et al. Liver resection of noncolorectal secondaries. J Surg Oncol 1998;69:66 –70. 3. Tomas-de la Vega JE, Donahue EJ, Doolas A, et al. A ten year experience with hepatic resection. Surg Gynecol Obstet 1984; 159:223–8. 4. Berney T, Mentha G, Roth AD, et al. Results of surgical resection of liver metastases from non-colorectal primaries. Br J Surg 1998;85:1423–7. 5. Schwartz SI. Hepatic resection for noncolorectal nonneuroendocrine metastases. World J Surg 1995;19:72–5. 6. Hamy A, Mirallie´ P, Bizouarn P, et al. Liver resection for non colorectal, noneuroendocrine metastases. Results of 32 hepatectomies in 27 patients. Ann Chir 2000;125:124 –30. 7. Cobourn CS, Makowka L, Langer B, et al. Examination of patients selection and outcome for hepatic resection for metastatic disease. Surg Gynecol Obstet 1987;165:239 –46. 8. Foster JH. Survival after liver resection for secondary tumors. Am J Surg 1978;135:389 –94.
releasing hormone analog (GnRH-analog) therapy. She is currently symptom-free after 14 months of follow-up.
CASE REPORT DI CARLO ET AL RESECTED LIVER METASTASES FROM LUNG CANCER
291
6. Rock JA, Markham SM. Pathogenesis of endometriosis. Lancet 1992;340:1264 –7.
Comment
We thank Shunji Kawamura, MD, for pathologic support.
References 1. Lillington GA, Mitchell SP, Wood GA. Catamenial pneumothorax. JAMA 1972;219:1328 –32. 2. Van Schil PE, Vercauteren SR, Vermeire PA, Nackaerts YH, Van Marck EA. Catamenial pneumothorax caused by thoracic endometriosis. Ann Thorac Surg 1996;62:585–6. 3. Cowl CT, Dunn WF, Deschamps C. Visualization of diaphragmatic fenestration associated with catamenial pneumothorax. Ann Thorac Surg 1999;68:1413–4. 4. Blanco S, Hernando F, Go´ mez A, Gonza´ lez MJ, Torres AJ, Balibrea JL. Catamenial pneumothorax caused by diaphragmatic endometriosis. J Thorac Cardiovasc Surg 1998;116:179 – 80. 5. Flieder DB, Moran CA, Travis WD, Koss MN, Mark EJ. Pleuro-pulmonary endometriosis and pulmonary ectopic deciduosis: a clinicopathologic and immunohistochemical study of 10 cases with emphasis on diagnostic pitfalls. Hum Pathol 1998;29:1495–503. © 2003 by The Society of Thoracic Surgeons Published by Elsevier Inc
Liver Metastases From Lung Cancer: Is Surgical Resection Justified? Isidoro Di Carlo, MD, PhD, Giuseppe Grasso, MD, Domenico Patane’, MD, Domenico Russello, MD, and Ferdinando Latteri, MD Department of Surgical Sciences, Organs Transplantation and Advanced Technologies, University of Catania, and Departments of Pathology and Radiology, Cannizzaro Hospital, Catania, Italy
Resection of the liver for metastatic lesions has largely been done for secondary colorectal or neuroendocrine tumors, and there is little information of its value for other lesions. Recent improvements in hepatic surgery have made resection of metastases a safe procedure and it should certainly be considered whenever there is an isolated lesion. We report the case of a successful resection of an isolated secondary hepatic lesion from a lung primary tumor, which was resected approximately 4 years beforehand. A review of the literature demonstrates that although early reports of similar procedures were not favorable, more recent reports reinforce the value of an aggressive approach in favorable cases. (Ann Thorac Surg 2003;76:291–3) © 2003 by The Society of Thoracic Surgeons
L
iver resections for metastases are commonly performed for colorectal primary tumors and are poorly documented for noncolorectal tumors. Several authors suggest that liver resection of noncolorectal secondaries, unless from Wilms tumor, should be discouraged [1], whereas others take the view that selected patients are candidates for hepatic resection [2]. Few cases of resected liver metastases from lung cancer are present in the literature. The aim of this study is to report a patient operated on for isolated liver metastasis from lung cancer and review the literature. A 69-year-old woman had a lobectomy for an adenocarcinoma of the lung in June 1995, which staged well. Four years later at routine follow-up, she was found to have a 5-cm lesion in the liver located in segment VII (Fig 1). The patient remained in good health and neither a gastroscopy or colonoscopy showed evidence of an occult primary. Total body scintigraphy demonstrated no other
Accepted for publication Dec 23, 2002. Address reprint requests to Prof Di Carlo, Department of Surgical Sciences, Organs Transplantation and Advanced Technologies, University of Catania, Cannizzaro Hospital, Via Messina, Catania 95126, Italy; e-mail: [email protected].
0003-4975/03/$30.00 PII S0003-4975(03)00149-8
CASE REPORTS
Four theories for the pathogenesis of CP have been proposed: (1) loss of cervical mucus during the menstrual phase, allowing movement of air into the peritoneum, then the air traverses through the diaphragmatic fenestrations into the pleural space [1– 4]; (2) spontaneous rupture of bullae or blebs during hormonal changes [2]; (3) elevated levels of prostaglandin in the serum during menstruation, which could cause severe vascular and bronchoalveolar constriction, producing alveolar rupture [2, 4]; and (4) ectopic endometrial tissue in the visceral pleura and its desquamation during menstruation [4, 5]. Given that our patient had previously had a hysterectomy, it is unlikely that the CP was caused by movement of air through the cervix. In our patient, no blebs or bullae were found after careful thoracoscopic inspection of the lung. Thus, our report supports the theory that CP is caused by endometrial implants, which could have traveled across diaphragmatic fenestrations or lymphatic channels to reach the visceral pleura [2, 3]. A common theory regarding the cause of endometriosis is that viable endometrial cells can reflux through the fallopian tubes during menstruation, implant, and grow on the surrounding pelvic structures and peritoneum [6]. These cells could implant in the visceral pleura through the fenestrations in the diaphragm; however, pathologically confirmed endometriosis in the visceral pleura is extremely rare in the literature [5]. Our case confirms that visceral pleural endometriosis can be a cause for CP. Previous case reports of recurrent CP after diaphragmatic resection could theoretically be due to visceral endometrial implants. Therefore, careful inspection of the entire lung surface at the time of operation for CP is mandatory and systemic therapy with GnRH-analogs [2, 4], pleurodesis, or both should be considered on the treatment for CP.
292
CASE REPORT DI CARLO ET AL RESECTED LIVER METASTASES FROM LUNG CANCER
Ann Thorac Surg 2003;76:291–3
Fig 1. Computed tomographic scan showing isolated liver metastasis from the lung, located at segment VII.
CASE REPORTS
metastatic lesions. Serum markers including ␣-fetoprotein and carcino-embryogenic antigen were normal, and in view of the patient’s good health and the long period of time from the original operation, surgical resection was advised. At operation no other lesions were demonstrated and a limited resection was performed without difficulty. The postoperative course was uneventful, and the patient was discharged 5 days later. Pathologic examination of the lesion confirmed a metastatic adenocarcinoma of the lung (Fig 2). The patient had now been followed-up for 3 years with no evidence of any recurrence or other problem.
Comment Resection of metastases in the liver from a colorectal primary is now well established and has been shown to improve survival. Favorable factors are the single metastasis, rather than the multiple metastases; the grading and staging of the primary tumor; and the length of time between removal of the primary tumor and appearance of the metastases, with greater length of time being more favorable [3, 4]. Surgery for secondary metastases in the liver is also
Fig 2. Liver metastasis showing focal glandular differentiation.
accepted for neuroendocrine, testicular, and renal primaries and has been reported in certain sarcomas, breast, and gynecological cancer and melanoma[5]. However, there have not been many reports of resection after treatment of a bronchogenic carcinoma, although generally this is one of the most common cancers [6]. We have reviewed the literature and found 12 reports of metastases from the lung, frequently combined with some other rare metastases from different origins. Unfortunately several of the reports really give insufficient information for adequate analysis (Table 1). However, it is clear that reports published before 1988 did not consider that resection of metastases was worthwhile [7, 8]. More recent reports have been more favorable and this probably reflects the improvements in liver surgery that have since taken place. Although we appreciate that the situation of our patient is unusual for bronchogenic carcinoma, the fact that nonsmall cell carcinoma of the lung is relatively resistant to cytotoxic chemotherapy makes surgery worthwhile. We were naturally suspicious that the lesion in the liver may well have been a metastasis from an occult abdominal primary tumor, but extensive investigation failed to reveal any indication of this. As yet, we do not have access to positron emission tomography, but reports in the literature suggest that this modality will be helpful
Table 1. Main Characteristics of Patients Operated On for Liver Metastases From Lung Cancer Reported in the Literature Authors (reference) Berney et al [4] Cobourn et al [7] Foster et al [8] Hamy et al [6] Lindell et al [2] Schwartz [5] Stehlin et al [1] Tomas-de la Vega et al [3] Personal report
Number of Cases
Pathology of the Primitive Tumor
Type of Hepatic Resection
Survival (mo)
3 1 2 1 1 2 1 1 1
No showed No showed No showed Epidermoid tumor Bronchial carcinoma No showed No showed No showed Adenocarcinoma
No showed No showed No showed Minor resection No showed No showed Major resection No showed Minor resection
No showed No showed No showed 13 185 ⬎60 9 No showed 36
Ann Thorac Surg 2003;76:293–5
CASE REPORT SHUNSUKE ET AL MALT LYMPHOMA IN THE THYMUS
293
in similar cases in ruling out occult primaries or other unexpected secondary lesions.
References
Mucosa-Associated Lymphoid Tissue Lymphoma of the Thymus Resected Using Combined Thoracoscopic and Transcervical Approaches Shunsuke Yamada, MD, Kohno Tadasu, MD, Mun Mingyon, MD, Abe Yoshiaki, MD, and Motoi Noriko, MD Departments of Thoracic Surgery and Pathology, Toranomon Hospital, Toranomon Hospital, Tokyo, Japan
Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade variant of B cell lymphoma that arises in extranodal tissue of the gastrointestinal tract, lung, salivary gland, thyroid, or other organ derived from the foregut. However, MALT lymphoma in the thymus is extremely rare. We report a case of thymic MALT lymphoma, extending to the neck, resected using combined thoracoscopic and transcervical approaches. To the best of our knowledge, thoracoscopic management of MALT lymphoma in the thymus has not previous been reported. (Ann Thorac Surg 2003;76:293–5) © 2003 by The Society of Thoracic Surgeons
Accepted for publication Nov 25, 2002. Address reprint requests to Dr Yamada, Tokai University Hachioji Hospital, 1838 Isikawa Hachioji, Tokyo 192-0032, Japan; e-mail: yamada. [email protected].
© 2003 by The Society of Thoracic Surgeons Published by Elsevier Inc
Fig 1. Computed tomography reveals an anterior and superior mediastinal mass with solid and cystic portions.
M
ucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade variant of B cell lymphoma that arises in extranodal tissue of the gastrointestinal tract, lung, salivary gland, thyroid, or other organ derived from the foregut. Mucosa-associated lymphoid tissue lymphoma tends to grow locally, remain clinically indolent, and respond well to surgery [1]. Mucosa-associated lymphoid tissue lymphoma of the thymus, which is extremely rare, has been excised through median sternotomy or thoracotomy in all previously reported cases [1– 6]. We report a case of thymic MALT lymphoma resected by video-assisted thoracoscopic surgery (VATS) combined with a transcervical approach. A 46-year-old woman with Sjo¨ gren’s syndrome was found to have a large anterior and superior mediastinal tumor by an annual radiographic examination of the chest. Her only symptom was a dry eye, and no lymph nodes were palpable. Computed tomography (CT) of the chest revealed a follicular cystic tumor in the anterior and superior mediastinum, extending to the lower end of the thyroid gland, without lymph node enlargement (Fig 1). All laboratory tests were normal. For access to the cervical and mediastinal aspects of the tumor, we planned to combine transcervical and videoassisted thoracoscopic surgery (VATS) approaches under single-lung ventilation anesthesia. We placed the patient in a 10° semileft-lateral position with her neck extended. A 3-cm-long transverse incision above the sternal notch exposed the cervical end of an encapsulated tumor, with no involvement of surrounding tissues. After mobilizing the upper part of the tumor using electrical cautery and finger dissection, we performed a videoscopic approach with three flexible thoracoports (7-, 10-, and 10-mm diameter) in the right chest. The chest mass was a grayish, encapsulated, multicystic tumor occupying the anterior and superior mediastinum, without involvement of pulmonary tissues. Tumor dissection proceeded cephalad, and from right to left. Two thymic vessels were clipped and divided, and the tumor was completely 0003-4975/03/$30.00 PII S0003-4975(02)04965-2
CASE REPORTS
1. Stehlin JS Jr, De Ipolyi PD, Greeff PJ, et al. Treatment of cancer of the liver. Twenty years’ experience with infusion and resection in 414 patients. Ann Surg 1988;208:23–35. 2. Lindell G, Ohlsson B, Saarela A, et al. Liver resection of noncolorectal secondaries. J Surg Oncol 1998;69:66 –70. 3. Tomas-de la Vega JE, Donahue EJ, Doolas A, et al. A ten year experience with hepatic resection. Surg Gynecol Obstet 1984; 159:223–8. 4. Berney T, Mentha G, Roth AD, et al. Results of surgical resection of liver metastases from non-colorectal primaries. Br J Surg 1998;85:1423–7. 5. Schwartz SI. Hepatic resection for noncolorectal nonneuroendocrine metastases. World J Surg 1995;19:72–5. 6. Hamy A, Mirallie´ P, Bizouarn P, et al. Liver resection for non colorectal, noneuroendocrine metastases. Results of 32 hepatectomies in 27 patients. Ann Chir 2000;125:124 –30. 7. Cobourn CS, Makowka L, Langer B, et al. Examination of patients selection and outcome for hepatic resection for metastatic disease. Surg Gynecol Obstet 1987;165:239 –46. 8. Foster JH. Survival after liver resection for secondary tumors. Am J Surg 1978;135:389 –94.