Importance of liver resection in case of hepatic breast cancer metastases.

BACKGROUND/AIMS: Primary focus of the therapy of metastatic breast cancer is currently a systemic therapy. Surgical therapies are of minor importance. Aim of this study was to investigate the relevance of hepatectomy in case of hepatic breast cancer metastases (HBCM) as an important part of multimodal therapy. METHODOLOGY: From January 2002 to December 2011, 30 patients with HBCM underwent hepatectomy. Criteria for hepatectomy were good condition, technical feasibility and control of extrahepatic metastases. For a heterogeneous group of women with HBCM the 3- and 5-year survival rate was determined by Kalpan-Meier survival estimate. RESULTS: The postoperative morbidity was 13.3%, the mortality rate was 3.3%. Minor hepatectomy has been performed in 62.1% and major hepatectomy in 37.9% of the cases. In all patients a R0 resection margin was performed. At a median follow-up interval of 34.1 months, 16 patients were still alive. The 3- and 5-year survival rates after surgically resection of HBCM in our collective were 31.0% and 20.7%. CONCLUSIONS: Hepatectomy is a safe therapy with low morbidity, mortality and improves long-term survival in most patients with limited, resectable HBCM. In our opinion patient selection should not be that strict. The combination of systemic and surgical therapies can improve prognosis and long-term survival of these patients.

"Incidentaloma" of the liver: management of a diagnostic and therapeutic dilemma.

The continuous development of highly sensitive clinical imaging increased the detection of focal lesions of the liver. These accidentally detected liver tumors without liver-specific symptoms such as cholestasis have been named "incidentalomas." Diagnostic tools such as sonography, computed tomography, or magnetic resonance imaging are used increasingly in asymptomatic individuals without defined suspected diagnoses in the setting of general prevention or followup after a history of malignancy. But despite continuous improvement of diagnostics, some doubt regarding the benign or malign behavior of a tumor remains. In case an asymptomatic hemangioma or FNH can be preoperatively detected with certainty, the indication for surgery must be very strict. In case of symptomatic liver lesions surgical resection should only be indicated with tumor-specific symptoms. In the remaining cases of benign lesions of the liver, a "watch and wait" strategy is recommended. In case of uncertain diagnosis, especially in patients with positive history of a malignant tumor or the suspected diagnosis of hepatocellular adenoma, surgical resection is indicated. Due to the continuous improvement of surgical techniques, liver resection should be done in the laparoscopic technique. Laparoscopic surgery has lower morbidity and shorter hospitalization than open technique.