Resection of Breast Cancer Liver Metastases

Abstract

Evidence is scarce but promising, the existing multidisciplinary approach should be expanded to consider surgical resection on top of current guidelines (systemic treatments) for a selected group of breast cancer liver metastases patients. For this research project, patients who underwent liver resection for breast cancer liver metastases were examined and subsequently compared to patients who were not operated on. Both groups receiving systemic treatments. The results of this study strongly suggest that hepatectomy should be considered in all patients with breast cancer metastases confined to the liver, when technically feasible and responding to systemic treatment. Liver resection provides a chance of long-term survival in selected patients with an acceptable risk of morbidity and mortality. Our nomogram can help to identify patients who may benefit the most from hepatic resection and can help clinicians and patients to make a more informed decision when advocating for resection. When comparing patients who receive hepatic resection combined with systemic treatment with systemic treatment only, those who had a hepatectomy lived more than twice as long as those who were treated with systemic treatment alone. In patient with recurrences, repeat hepatectomy has yielded long-term survival in selected patients without increased morbidity and mortality. The presence of combined extrahepatic recurrence and the impossibility to perform an R0 resection should possibly be considered as a formal contraindication for surgery. Control of the metastatic disease by perioperative systemic treatment is also mandatory. Through an aggressive approach combining systemic therapy with surgical resection which includes repeat resections, some patients experienced survival comparable to the general population. This is rarely found in patients treated with a palliative approach to breast cancer liver metastases. When examining tumoral tissue removed through hepatectomies over time, PIK3CA mutations were frequently present in breast cancer liver metastases and persist over time. Intertumoral genetic heterogeneity was also observed and challenges our understanding of breast cancer evolution.