Liver Metastases From Breast Cancer: What Role for Surgery? Indications and Results
Liver metastases from breast cancer (LMBC) have long been considered as a systemic disease because of the hematological route of dissemination, requiring noncurative management. In fact, despite recent advances in drug therapies personalized to tumor phenotype, the chances of a cure are nil and there is little hope of long-term survivors after nonsurgical management alone. By contrast, there is a growing evidence in the literature for satisfactory long-term results after a combination of chemotherapy and liver resection, with 5-year survival reaching >40% in some series. The surgical management of LMBC is still restricted to carefully selected patients, managed in high-volume hepatobiliary surgery and cancer research centers. Under these conditions, resection can be performed at the price of very limited morbidity and near zero mortality. The best results after the resection of LMBC are obtained after applying selection criteria based on small metastases (<4-5 cm), minor hepatectomy, radical resection (ideally R0, or R1), stable disease (ideally in regression) after neoadjuvant therapy, and a delay between primary and secondary lesions longer than 1 or 2 years (reflecting a favorable oncologic context). The age of the patient, her hormone receptor status, and HER2 overexpression are not strong predictors of survival. The role of radiological alternatives still needs to be defined (radiofrequency, microwave ablation, radioembolization), and these raise questions regarding a reliable pretreatment assessment of tumor spread. Finally, surgical results are based on scarce evidence and need to be confirmed by large-scale studies so that they will be more widely accepted by the medical community.