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Liver tumors in oncological patients: Not always liver metastasis
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E-AHPBA: Poster Abstracts
LIVER 0228 LIVER TUMORS IN ONCOLOGICAL PATIENTS: NOT ALWAYS LIVER METASTASIS A. Kuhnhardt, J. D. Gonzales, J. C. Valenzuela, C. Garcia-Amador, A. Lopez-Marcano, R. De la Plaza and J. M. Ramia Hospital de Guadalajara, Spain Aims: The development of new liver solid lesions in cancer patients, usually is due to the presence of metastatic disease in the liver. Only in a small number of patients may appear other primary tumours, but this scenario is infrequent. When the radiologic appearance of these new lesions is not deniable benign or if there is a concomitant rising of tumoral markers or a doubtful PET, the first suspect diagnosis is liver metastasis and reaching a correct differential diagnosis preoperatively. Methods: We present three oncological patients who we had diagnosed new hepatic focal lesions in the follow up of his oncological disease. Radiological exams were non conclusive and we decided to perform resection of the tumours. PET was positive in two cases. Pathological studies confirm three unusual benign tumours. Results: See Table I Conclusions: The most common solid benign hepatic tumours include cavernous hemangioma, focal nodular hyperplasia and liver cell adenoma, but other infrequent neoplasms could develop in the liver of oncological patients as nodular regenerative hyperplasia inflammatory pseudotumour or reactive lymphoid hyperplasia. Radiological expertise is crucial to perform a correct preoperative diagnosis but sometimes is not possible and liver resection is best option. We present a wide iconography of these 3 very rare tumours and discuss etiology of each case.
LIVER 0259 LIVER RESECTION FOR METACHRONOUS HEPATIC METASTASES FROM CERVICAL CANCER N. Bacalbasa1, S. Dima2, I. Balescu3, V. Brasoveanu2 and I. Popescu2 1 Carol Davila University of Medicine and Pharmacy; 2 Dan Setlacec Fundeni Clinical Institute Bucharest; 3 Ponderas Hospital Bucharest, Romania Aims: To demonstrate the effectiveness of liver resection in metachronous liver metastases from cervical cancer. Methods: Between January 2002eApril 2014 13 patients with metachronous liver metastases from cervical cancer were treated surgically in Fundeni Clinical Hospital. Results: The mean age at the moment of cervical cancer diagnosis was 50,4 years while disease free survival between surgery for cervical cancer and re-apparition of symptoms was 20 months. At the moment of diagnosis of liver metastases 11 patients presented unique lesions while the other two were diagnosed with 4 respectively 2 lesions. In three cases pelvic recurrence was also reported. In all cases complete resection was performed. Major hepatectomies (involving more than 3 hepatic segments) were performed in four cases while in the other nine cases minor hepatectomies were needed. Postoperative morbidity
related to liver surgery was 15,2% (2/13 cases) and was represented by biliary fistula (1 case) and pleural effusion after resection of a large metastasis involving the entire right lobe (1 case). Both cases were treated conservatory and were discharged in 11th respectively 18th postoperative day. Postoperative mortality was 7,6% (1 of 13 cases) and was not related to liver surgery (the patient encountered an urinary fistula after resection of a pelvic recurrence). The median survival after liver resection was 17,9 months. In univariate analysis the most important factors associated with an improved survival were the general status of the patient (ASA score 1e2 versus 3e4, p = 0,05), tumor grade of differentiation G2 versus G3 (p = 0,021) and the absence of pelvic recurrence (p = 0,02). Major hepatectomies were not associated with a poorer outcome when compared to minor resections (p = 0,363). Conclusions: Liver resection for metachronous hepatic metastases from cervical cancer is safe and can bring survival benefit.
LIVER 0260 LIVER RESECTION AT THE MOMENT OF PRIMARY CYTOREDUCTION FOR EPITHELIAL OVARIAN CANCER LIVER METASTASES N. Bacalbasa1, S. Dima2, I. Balescu3, V. Brasoveanu2 and I. Popescu2 1 Carol Davila University of Medicine and Pharmacy; 2 Dan Setlacec Fundeni Clinical Institute Bucharest; 3 Ponderas Hospital Bucharest, Romania Aims: To evaluate the role of surgical resection of liver metastases at the moment of primary cytoreduction in advanced epithelial ovarian cancer. Methods: At the moment of primary cytoreduction, 11 patients with ovarian cancer liver metastases were submitted to hepatic resections in Fundeni Clinical Hospital between January 2002eApril 2014. Metastases originating from peritoneal seeding with parenchimatous invasion of at least 2 cm were classified as peritoneal lesions while lesions entirely surrounded by liver parenchyma were classified as hematogenous lesions. Results: The mean age at the moment of primary cytoreduction was 54 years. Two of the 11 patients were submitted to neo-adjuvant chemotherapy. The main histopathological types were serous (8 cases), endometrial (1 case) and other subtypes (2 cases). The peritoneal route of dissemination was incriminated in 4 cases while hematogenous dissemination was encountered in the other 7 cases. In eight cases an R0 resection was performed. Minor hepatectomies (involving less than 2 liver segments) were performed in 8 cases, major hepatectomy (resection of more than 2 liver segments) was performed in 1 case while in another cases radiofrequncy ablation was performed. Postoperative morbidity was 18% (2/11 cases) while postoperative mortality was 0. Long term outcomes revealed a 103 months median overall survival for cases with liver metastases from peritoneal origin and only 12 months for cases with hematogenous liver metastases (p = 0,227). Conclusions: Hepatic resection for ovarian cancer liver metastases can be safely introduced as part of cytoreductive surgery and may improve survival.
HPB 2016, 18 (S2), e685ee738
E-AHPBA: Poster Abstracts
LIVER 0228 LIVER TUMORS IN ONCOLOGICAL PATIENTS: NOT ALWAYS LIVER METASTASIS A. Kuhnhardt, J. D. Gonzales, J. C. Valenzuela, C. Garcia-Amador, A. Lopez-Marcano, R. De la Plaza and J. M. Ramia Hospital de Guadalajara, Spain Aims: The development of new liver solid lesions in cancer patients, usually is due to the presence of metastatic disease in the liver. Only in a small number of patients may appear other primary tumours, but this scenario is infrequent. When the radiologic appearance of these new lesions is not deniable benign or if there is a concomitant rising of tumoral markers or a doubtful PET, the first suspect diagnosis is liver metastasis and reaching a correct differential diagnosis preoperatively. Methods: We present three oncological patients who we had diagnosed new hepatic focal lesions in the follow up of his oncological disease. Radiological exams were non conclusive and we decided to perform resection of the tumours. PET was positive in two cases. Pathological studies confirm three unusual benign tumours. Results: See Table I Conclusions: The most common solid benign hepatic tumours include cavernous hemangioma, focal nodular hyperplasia and liver cell adenoma, but other infrequent neoplasms could develop in the liver of oncological patients as nodular regenerative hyperplasia inflammatory pseudotumour or reactive lymphoid hyperplasia. Radiological expertise is crucial to perform a correct preoperative diagnosis but sometimes is not possible and liver resection is best option. We present a wide iconography of these 3 very rare tumours and discuss etiology of each case.
LIVER 0259 LIVER RESECTION FOR METACHRONOUS HEPATIC METASTASES FROM CERVICAL CANCER N. Bacalbasa1, S. Dima2, I. Balescu3, V. Brasoveanu2 and I. Popescu2 1 Carol Davila University of Medicine and Pharmacy; 2 Dan Setlacec Fundeni Clinical Institute Bucharest; 3 Ponderas Hospital Bucharest, Romania Aims: To demonstrate the effectiveness of liver resection in metachronous liver metastases from cervical cancer. Methods: Between January 2002eApril 2014 13 patients with metachronous liver metastases from cervical cancer were treated surgically in Fundeni Clinical Hospital. Results: The mean age at the moment of cervical cancer diagnosis was 50,4 years while disease free survival between surgery for cervical cancer and re-apparition of symptoms was 20 months. At the moment of diagnosis of liver metastases 11 patients presented unique lesions while the other two were diagnosed with 4 respectively 2 lesions. In three cases pelvic recurrence was also reported. In all cases complete resection was performed. Major hepatectomies (involving more than 3 hepatic segments) were performed in four cases while in the other nine cases minor hepatectomies were needed. Postoperative morbidity
related to liver surgery was 15,2% (2/13 cases) and was represented by biliary fistula (1 case) and pleural effusion after resection of a large metastasis involving the entire right lobe (1 case). Both cases were treated conservatory and were discharged in 11th respectively 18th postoperative day. Postoperative mortality was 7,6% (1 of 13 cases) and was not related to liver surgery (the patient encountered an urinary fistula after resection of a pelvic recurrence). The median survival after liver resection was 17,9 months. In univariate analysis the most important factors associated with an improved survival were the general status of the patient (ASA score 1e2 versus 3e4, p = 0,05), tumor grade of differentiation G2 versus G3 (p = 0,021) and the absence of pelvic recurrence (p = 0,02). Major hepatectomies were not associated with a poorer outcome when compared to minor resections (p = 0,363). Conclusions: Liver resection for metachronous hepatic metastases from cervical cancer is safe and can bring survival benefit.
LIVER 0260 LIVER RESECTION AT THE MOMENT OF PRIMARY CYTOREDUCTION FOR EPITHELIAL OVARIAN CANCER LIVER METASTASES N. Bacalbasa1, S. Dima2, I. Balescu3, V. Brasoveanu2 and I. Popescu2 1 Carol Davila University of Medicine and Pharmacy; 2 Dan Setlacec Fundeni Clinical Institute Bucharest; 3 Ponderas Hospital Bucharest, Romania Aims: To evaluate the role of surgical resection of liver metastases at the moment of primary cytoreduction in advanced epithelial ovarian cancer. Methods: At the moment of primary cytoreduction, 11 patients with ovarian cancer liver metastases were submitted to hepatic resections in Fundeni Clinical Hospital between January 2002eApril 2014. Metastases originating from peritoneal seeding with parenchimatous invasion of at least 2 cm were classified as peritoneal lesions while lesions entirely surrounded by liver parenchyma were classified as hematogenous lesions. Results: The mean age at the moment of primary cytoreduction was 54 years. Two of the 11 patients were submitted to neo-adjuvant chemotherapy. The main histopathological types were serous (8 cases), endometrial (1 case) and other subtypes (2 cases). The peritoneal route of dissemination was incriminated in 4 cases while hematogenous dissemination was encountered in the other 7 cases. In eight cases an R0 resection was performed. Minor hepatectomies (involving less than 2 liver segments) were performed in 8 cases, major hepatectomy (resection of more than 2 liver segments) was performed in 1 case while in another cases radiofrequncy ablation was performed. Postoperative morbidity was 18% (2/11 cases) while postoperative mortality was 0. Long term outcomes revealed a 103 months median overall survival for cases with liver metastases from peritoneal origin and only 12 months for cases with hematogenous liver metastases (p = 0,227). Conclusions: Hepatic resection for ovarian cancer liver metastases can be safely introduced as part of cytoreductive surgery and may improve survival.
HPB 2016, 18 (S2), e685ee738