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www.CirurgiaOnline.com.br
Oncology Surgeon of the Brazilian National Cancer Institute
President of the Brazilian Chapter of the International Hepato Biliary Pancreatic Association (CB-IHPBA)
Compagnon Hepatobiliare
www.CirurgiaOnline.com.br
HEPATIC METASTASES OF SARCOMA
INTRODUCTION
Sarcomas are mesodermic origin tumors, low frequency
and several times arrived with advanced disease in our
center.
NCI Brazil
66587 last 10 y => near 1531 (2,29%) sarcomas
Hepatic Metastases = stage IV
Up to 60% Hepatic Metastases in Abdominal Sarcomas
www.CirurgiaOnline.com.br
Resections of Colorectal Metastases
Well Established
Hepatic Metastases of Sarcomas
?
HEPATIC METASTASES OF SARCOMA
INTRODUCTION
www.CirurgiaOnline.com.br
Hepatic resection for Noncolorectal Nonendocrine Liver
Metastases. Analysis of 1452 patients and development of a
Prognostic Model.
Adan R, Chiche L, Aloia T and others.
Ann Surg. 2006 Oct;244(4):524-35; French Group
www.CirurgiaOnline.com.br
1452 patients 1983 – 2004
56% solitary - 71% unilateral - Med 5,05 cm
GIST/Sarcoma (33/125 - 13,5%)
Metachronous 76%
83% R0, Mortality rate 2,3%
Overall 5 and 10 years => 36% and 23%
Recurrence free survival 11 months
5y surv GIST 70% and Sarcoma 31%
Hepatic resection for Noncolorectal Nonendocrine Liver
Metastases. Analysis of 1452 patients and development of a
Prognostic Model.
Adan R, Chiche L, Aloia T and others.
Ann Surg. 2006 Oct;244(4):524-35; French Group
www.CirurgiaOnline.com.br
Except for patients with gastrointestinal stromal tumors
(GIST), systemic chemotherapy in patients with liver metastasis
of soft-tissue sarcoma (STS) is not effective.
We believe that all patients with resectable liver metastases
should underwent surgical therapy.
HEPATIC METASTASES OF SARCOMA
INTRODUCTION
www.CirurgiaOnline.com.br
Results of hepatic resection for sarcoma metastatic to liver.
DeMatteo RP, Shah A, Fong Y, Jarnagin WR, Blumgart LH, Brennan MF.
Ann Surg. 2001 Oct;234(4):540-7; discussion 547-8. Memorial Sloan-Kettering Cancer Center
56 pac in 331 between 1982 – 2000
34 (61%) GIST or Leiomyossarcoma Gastrointestinal
50% Major Hepatectomies ( > 3 Segments)
Zero Mortality
Survival in 1, 3 and 5 y R0 = 88%, 50% and 30%
5 y survival R1 and R2 = 4%
Median surv 39 months GIST = Leiomyossarcoma
HEPATIC METASTASES OF SARCOMA
Before Imatinib
www.CirurgiaOnline.com.br
Results of hepatic resection for sarcoma metastatic to liver.
DeMatteo RP, Shah A, Fong Y, Jarnagin WR, Blumgart LH, Brennan MF.
Ann Surg. 2001 Oct;234(4):540-7; discussion 547-8. Memorial Sloan-Kettering Cancer Center
Multivariate Analysis => Metachronous > 2 years
45 (80%) Metachronous disease > 2 years in 57%
Recurrence 47 (84%) Med 16 months (liver)
Highly selected
Conclusion:
Hepatectomies must be performed when R0 is
possible and increase survival.
HEPATIC METASTASES OF SARCOMA
www.CirurgiaOnline.com.br
Results of a single-center experience with resection and
ablation for sarcoma metastatic to liver.
Pawlik TM, Vauthey JN, Abdala EK, Pollock RE, Ellis LM, Curley SA. Arch Surg. 2006
Jun;141(6):537-43. Huston Texas
1996 – 2005
66 patients, Median 3 lesions with 3,9 cm, bilobar
36 GIST , 18 Leiomyosarcoma, 12 Others
35 Resection, 13 Radiofrequency, 18 Both
66,7% Recurrence, More Radiofrequency (p < 0,05)
1, 3 and 5 years survival 91,2%, 65,4% and 27,1% (47,2 months)
GIST with Imatinib Mesylate => Longest Survival p = 0,003 and
Disease free survival
Complication Rate 15,2%, Mortality 4,5%
HEPATIC METASTASES OF SARCOMA
www.CirurgiaOnline.com.br
Results of a single-center experience with resection and
ablation for sarcoma metastatic to liver.
Pawlik TM, Vauthey JN, Abdala EK, Pollock RE, Ellis LM, Curley SA. Arch Surg. 2006 Jun;141(6):537-43.
Huston Texas
Good Prognostic Factors
• Size < 3 cm
• Surgery alone
• Chemotherapy pre or post op
• Imatinib in GIST
HEPATIC METASTASES OF SARCOMA
www.CirurgiaOnline.com.br
Hepatic metastasectomy for soft-tissue sarcomas: is it justified?
Rehders A, Peiper M, Stoecklein NH, Alexander A, Boelke E, Knoefel WT, Rogiers X.
World J Surg. 2009 Jan;33(1):111-7
• 27 hepatic resection patients; 1995 to 2008.
• 59% Solitary metastasis, 22% had two metastases, and 18% had three
or more metastatic nodules.
• Mortality 7%.
• The median survival was 44 (range, 1-123) months, and the 5-year
survival was 49%.
• Repeated resection for recurrent tumor was performed in eight
patients, which yielded a median survival of 76 months.
CONCLUSIONS:
Patients who have hepatic metastases that are functionally and
technically resectable should be considered for surgery because this
treatment offers the chance for long-term survival (>5 years).
www.CirurgiaOnline.com.br
Hepatic Resection of Soft Tissue Sarcomas
Silva R., Kesley R., Santos CER., Melo E., Dias J., Bravo GP.
Rev.Col. Bras. Cir. 2006; 33(6): 380-386.
• INCA 1992 - 2002 – 11 cases
• 5 gastrointestinal tract, 4 retroperitoneum, 1 uterus and 1 deltoid muscle.
• 10 leiomyosarcomas and 1 dermatofibrosarcoma.
• 6 G2 and 5 G3 tumors.
• 5 segmentectomies, 4 lobectomies and 2 major hepatic resections.
• 2 extra-hepatic associated resections.
• 7 R0
• OS complete resection with a 49-month survival for R0 resections compared to
a 15-month with residual disease (p<0.05).
• G2 a 49-month survival compared to a 15-month with G3 tumors (p<0.0447).
www.CirurgiaOnline.com.br
Hepatic Resection of Liver Metastases of Soft
Tissue Sarcoma
Silva R., Kesley R., Santos CER., Melo E., Dias J., Bravo GP.
Rev.Col. Bras. Cir. 2006; 33(6): 380-386.
Conclusion
Liver resections for hepatic metastasis of soft tissue
sarcomas can improve overall survival particularly
for patients with complete resection (R0) and for low
grade tumors.
Lead us to increased indication and pursuit of
radicality
www.CirurgiaOnline.com.br
Authors: Santos CER, Rosa BR, Meton F, Monteiro M
Brazilian National Cancer Institute
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Angiomyosarcoma Leiomyosarcoma
www.CirurgiaOnline.com.br
Material and Methods
• Retrospective study based on a
prospective data base of 28 patients
with hepatic metastases of
sarcoma, ressected at Brazilian National
Cancer Institute - INCA-Rio de
Janeiro, between 1996-2011.
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Results
• Patients
• Gender: 17 women (60.7%)
• 11 men (39.3%)
•
• Age: 30 - 72 y (median 55 y)
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Results
• Tumour 26 abdominal origin
• 8 Gastric;
• 7 Small Bowel;
• 6 Retroperitoneal;
• 2 Uterine;
• 1 IVC, Kidney, Colon, Breast and Deltoid.
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Results
• Histology:
• 16 (54.1%) - Leiomyosarcoma
• 8 (28.6%) - GIST
• 2 Endometrial Sarcomas
• 1 Fibrosarcoma
• 1 Angiosarcoma
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
• Histology:
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
Histology Median
Visceral 66.33
Non
Visceral
33.23
Overall 62.73
P= 0.208
www.CirurgiaOnline.com.br
Results
• Histology:
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
P= 0.171
Histology Median
GIST -
Others
Sarcomas
37.97
Overall 62.73
www.CirurgiaOnline.com.br
Results
• Tumour Grade:
G3 - 11 (39.3%)
• G2 - 8 (28.6%)
• G1 - 2 (7.1%)
GX – 4 (14.3%)
• Metastases Size: 2 to 25 cm (median 6 cm)
• 20 cases Metachronic – Median 30 months (5 - 292)
• 8 Synchronic disease
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Results
• Tumour Grade:
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
P= 0.529
www.CirurgiaOnline.com.br
Results
• Diagnostic
• CT 26 cases
• US 4 cases
• MRI 1 case
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Results
• Surgery
• - Types of resection:
• 15 Major Hepatectomies (2 1992-2002)
• 13 Segmentectomies (1, 2 or 3 seg)
• - Synchronic resection 5 cases (62.5%)
• - Synchronic resection of extra hepatic
disease in 13 cases (46.5%) (2 1992-2002)
MORE AGRESSIVE APROACH
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
RADIOFREQUENCY
ABLATION
www.CirurgiaOnline.com.br
Results
• Radicality
– R0: 18 patients (64.3%)
– R1: 03 patients (10.7%)
– R2: 7 patients (25%)
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Results
• Radicality
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
P= 0.876
Mean
R0 – 63 months
R1 + R2 – 34 months
www.CirurgiaOnline.com.br
Results
• Radicality
Without GIST
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
P= 0.229
Mean
R0 – 63 months
R1 + R2 – 33 months
www.CirurgiaOnline.com.br
Results
• Surgery
• Average Surgical time 332 min (180-840)
3h to 14h
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Results
• Surgery
• Hospitalisation 10 days
• Morbidity 25% - 7 cases
• Post op mortality (30 days): 1 case (3.6%)
• Pneumonia and wound infection
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Results
• Disease free survival 11 months (5-37)
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Results
• Median Overall Survival 63 months (1 – 105)
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
5y surv – 52.7%
www.CirurgiaOnline.com.br
Results
• Blood Transfusion x Survival
– No: 19 patients (68%) - SV 74 months
– Yes: 09 patients (32%) - SV 21 months
• Mean 1200 ml ( 600-1800 ml)
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
P= 0.001
www.CirurgiaOnline.com.br
Results
• Recurrence
- 76.5% R0 patients recurred (50% liver)
-7 patients 2nd resection
-4 patients 3rd resection
-2 patients 4th resection
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Results
• Repeat Resection
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
P= 0.060Repeat
Resection
Median
Yes 66.33
No 33.23
Overall 62.73
www.CirurgiaOnline.com.br
Results
• Treatment
• Neoadjuvant Radiotherapy 1 case
• Neoadjuvant Chemo 5 cases
• Adjuvant Radiotherapy 1 case
• Adjuvant Chemo 15 cases
• Adjuvant Radio + Chemo 3 cases
• No Other treatment 8 cases
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
www.CirurgiaOnline.com.br
Results
• Neo or Adjuvant treatment X Survival (R0)
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
P= 0.212 P= 0.668
www.CirurgiaOnline.com.br
Results
• OS Neo or Adjuvant treatment X Survival (All patients)
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
P= 0.703
www.CirurgiaOnline.com.br
Results
• OS Neo or Adjuvant treatment X Survival (GIST)
Analysis of the hepatectomies for
sarcoma metastases
15 years experience of NCI Brazil 1996-2011
P= 0.051
Adv.
Treat.
Median
GIST -
Others
Sarcomas
33.23
Overall 62.73
www.CirurgiaOnline.com.br
GENERALIZED PROGRESSION
Metastas
is
SURGERY NOT
RECOMMENDED
www.CirurgiaOnline.com.br
Conclusion
Although only 8 patients are alive at the
moment ( 6 GIST) and 2 are disease free
Imatinib - 2003
The Complete Resection and Repeat
Resection should improve survival and
is recommended.
Blood Transfusion should be Avoided
HEPATIC METASTASES OF SARCOMA
www.CirurgiaOnline.com.br
Good news Sir, We achieve a complete resection !
www.CirurgiaOnline.com.br

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Met hepsarcoma pequim final

  • 1. www.CirurgiaOnline.com.br Oncology Surgeon of the Brazilian National Cancer Institute President of the Brazilian Chapter of the International Hepato Biliary Pancreatic Association (CB-IHPBA) Compagnon Hepatobiliare
  • 2. www.CirurgiaOnline.com.br HEPATIC METASTASES OF SARCOMA INTRODUCTION Sarcomas are mesodermic origin tumors, low frequency and several times arrived with advanced disease in our center. NCI Brazil 66587 last 10 y => near 1531 (2,29%) sarcomas Hepatic Metastases = stage IV Up to 60% Hepatic Metastases in Abdominal Sarcomas
  • 3. www.CirurgiaOnline.com.br Resections of Colorectal Metastases Well Established Hepatic Metastases of Sarcomas ? HEPATIC METASTASES OF SARCOMA INTRODUCTION
  • 4. www.CirurgiaOnline.com.br Hepatic resection for Noncolorectal Nonendocrine Liver Metastases. Analysis of 1452 patients and development of a Prognostic Model. Adan R, Chiche L, Aloia T and others. Ann Surg. 2006 Oct;244(4):524-35; French Group
  • 5. www.CirurgiaOnline.com.br 1452 patients 1983 – 2004 56% solitary - 71% unilateral - Med 5,05 cm GIST/Sarcoma (33/125 - 13,5%) Metachronous 76% 83% R0, Mortality rate 2,3% Overall 5 and 10 years => 36% and 23% Recurrence free survival 11 months 5y surv GIST 70% and Sarcoma 31% Hepatic resection for Noncolorectal Nonendocrine Liver Metastases. Analysis of 1452 patients and development of a Prognostic Model. Adan R, Chiche L, Aloia T and others. Ann Surg. 2006 Oct;244(4):524-35; French Group
  • 6. www.CirurgiaOnline.com.br Except for patients with gastrointestinal stromal tumors (GIST), systemic chemotherapy in patients with liver metastasis of soft-tissue sarcoma (STS) is not effective. We believe that all patients with resectable liver metastases should underwent surgical therapy. HEPATIC METASTASES OF SARCOMA INTRODUCTION
  • 7. www.CirurgiaOnline.com.br Results of hepatic resection for sarcoma metastatic to liver. DeMatteo RP, Shah A, Fong Y, Jarnagin WR, Blumgart LH, Brennan MF. Ann Surg. 2001 Oct;234(4):540-7; discussion 547-8. Memorial Sloan-Kettering Cancer Center 56 pac in 331 between 1982 – 2000 34 (61%) GIST or Leiomyossarcoma Gastrointestinal 50% Major Hepatectomies ( > 3 Segments) Zero Mortality Survival in 1, 3 and 5 y R0 = 88%, 50% and 30% 5 y survival R1 and R2 = 4% Median surv 39 months GIST = Leiomyossarcoma HEPATIC METASTASES OF SARCOMA Before Imatinib
  • 8. www.CirurgiaOnline.com.br Results of hepatic resection for sarcoma metastatic to liver. DeMatteo RP, Shah A, Fong Y, Jarnagin WR, Blumgart LH, Brennan MF. Ann Surg. 2001 Oct;234(4):540-7; discussion 547-8. Memorial Sloan-Kettering Cancer Center Multivariate Analysis => Metachronous > 2 years 45 (80%) Metachronous disease > 2 years in 57% Recurrence 47 (84%) Med 16 months (liver) Highly selected Conclusion: Hepatectomies must be performed when R0 is possible and increase survival. HEPATIC METASTASES OF SARCOMA
  • 9. www.CirurgiaOnline.com.br Results of a single-center experience with resection and ablation for sarcoma metastatic to liver. Pawlik TM, Vauthey JN, Abdala EK, Pollock RE, Ellis LM, Curley SA. Arch Surg. 2006 Jun;141(6):537-43. Huston Texas 1996 – 2005 66 patients, Median 3 lesions with 3,9 cm, bilobar 36 GIST , 18 Leiomyosarcoma, 12 Others 35 Resection, 13 Radiofrequency, 18 Both 66,7% Recurrence, More Radiofrequency (p < 0,05) 1, 3 and 5 years survival 91,2%, 65,4% and 27,1% (47,2 months) GIST with Imatinib Mesylate => Longest Survival p = 0,003 and Disease free survival Complication Rate 15,2%, Mortality 4,5% HEPATIC METASTASES OF SARCOMA
  • 10. www.CirurgiaOnline.com.br Results of a single-center experience with resection and ablation for sarcoma metastatic to liver. Pawlik TM, Vauthey JN, Abdala EK, Pollock RE, Ellis LM, Curley SA. Arch Surg. 2006 Jun;141(6):537-43. Huston Texas Good Prognostic Factors • Size < 3 cm • Surgery alone • Chemotherapy pre or post op • Imatinib in GIST HEPATIC METASTASES OF SARCOMA
  • 11. www.CirurgiaOnline.com.br Hepatic metastasectomy for soft-tissue sarcomas: is it justified? Rehders A, Peiper M, Stoecklein NH, Alexander A, Boelke E, Knoefel WT, Rogiers X. World J Surg. 2009 Jan;33(1):111-7 • 27 hepatic resection patients; 1995 to 2008. • 59% Solitary metastasis, 22% had two metastases, and 18% had three or more metastatic nodules. • Mortality 7%. • The median survival was 44 (range, 1-123) months, and the 5-year survival was 49%. • Repeated resection for recurrent tumor was performed in eight patients, which yielded a median survival of 76 months. CONCLUSIONS: Patients who have hepatic metastases that are functionally and technically resectable should be considered for surgery because this treatment offers the chance for long-term survival (>5 years).
  • 12. www.CirurgiaOnline.com.br Hepatic Resection of Soft Tissue Sarcomas Silva R., Kesley R., Santos CER., Melo E., Dias J., Bravo GP. Rev.Col. Bras. Cir. 2006; 33(6): 380-386. • INCA 1992 - 2002 – 11 cases • 5 gastrointestinal tract, 4 retroperitoneum, 1 uterus and 1 deltoid muscle. • 10 leiomyosarcomas and 1 dermatofibrosarcoma. • 6 G2 and 5 G3 tumors. • 5 segmentectomies, 4 lobectomies and 2 major hepatic resections. • 2 extra-hepatic associated resections. • 7 R0 • OS complete resection with a 49-month survival for R0 resections compared to a 15-month with residual disease (p<0.05). • G2 a 49-month survival compared to a 15-month with G3 tumors (p<0.0447).
  • 13. www.CirurgiaOnline.com.br Hepatic Resection of Liver Metastases of Soft Tissue Sarcoma Silva R., Kesley R., Santos CER., Melo E., Dias J., Bravo GP. Rev.Col. Bras. Cir. 2006; 33(6): 380-386. Conclusion Liver resections for hepatic metastasis of soft tissue sarcomas can improve overall survival particularly for patients with complete resection (R0) and for low grade tumors. Lead us to increased indication and pursuit of radicality
  • 14. www.CirurgiaOnline.com.br Authors: Santos CER, Rosa BR, Meton F, Monteiro M Brazilian National Cancer Institute Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 16. www.CirurgiaOnline.com.br Material and Methods • Retrospective study based on a prospective data base of 28 patients with hepatic metastases of sarcoma, ressected at Brazilian National Cancer Institute - INCA-Rio de Janeiro, between 1996-2011. Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 17. www.CirurgiaOnline.com.br Results • Patients • Gender: 17 women (60.7%) • 11 men (39.3%) • • Age: 30 - 72 y (median 55 y) Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 18. www.CirurgiaOnline.com.br Results • Tumour 26 abdominal origin • 8 Gastric; • 7 Small Bowel; • 6 Retroperitoneal; • 2 Uterine; • 1 IVC, Kidney, Colon, Breast and Deltoid. Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 19. www.CirurgiaOnline.com.br Results • Histology: • 16 (54.1%) - Leiomyosarcoma • 8 (28.6%) - GIST • 2 Endometrial Sarcomas • 1 Fibrosarcoma • 1 Angiosarcoma Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 20. www.CirurgiaOnline.com.br • Histology: Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011 Histology Median Visceral 66.33 Non Visceral 33.23 Overall 62.73 P= 0.208
  • 21. www.CirurgiaOnline.com.br Results • Histology: Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011 P= 0.171 Histology Median GIST - Others Sarcomas 37.97 Overall 62.73
  • 22. www.CirurgiaOnline.com.br Results • Tumour Grade: G3 - 11 (39.3%) • G2 - 8 (28.6%) • G1 - 2 (7.1%) GX – 4 (14.3%) • Metastases Size: 2 to 25 cm (median 6 cm) • 20 cases Metachronic – Median 30 months (5 - 292) • 8 Synchronic disease Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 23. www.CirurgiaOnline.com.br Results • Tumour Grade: Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011 P= 0.529
  • 24. www.CirurgiaOnline.com.br Results • Diagnostic • CT 26 cases • US 4 cases • MRI 1 case Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 25. www.CirurgiaOnline.com.br Results • Surgery • - Types of resection: • 15 Major Hepatectomies (2 1992-2002) • 13 Segmentectomies (1, 2 or 3 seg) • - Synchronic resection 5 cases (62.5%) • - Synchronic resection of extra hepatic disease in 13 cases (46.5%) (2 1992-2002) MORE AGRESSIVE APROACH Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 27. www.CirurgiaOnline.com.br Results • Radicality – R0: 18 patients (64.3%) – R1: 03 patients (10.7%) – R2: 7 patients (25%) Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 28. www.CirurgiaOnline.com.br Results • Radicality Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011 P= 0.876 Mean R0 – 63 months R1 + R2 – 34 months
  • 29. www.CirurgiaOnline.com.br Results • Radicality Without GIST Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011 P= 0.229 Mean R0 – 63 months R1 + R2 – 33 months
  • 30. www.CirurgiaOnline.com.br Results • Surgery • Average Surgical time 332 min (180-840) 3h to 14h Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 31. www.CirurgiaOnline.com.br Results • Surgery • Hospitalisation 10 days • Morbidity 25% - 7 cases • Post op mortality (30 days): 1 case (3.6%) • Pneumonia and wound infection Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 32. www.CirurgiaOnline.com.br Results • Disease free survival 11 months (5-37) Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 33. www.CirurgiaOnline.com.br Results • Median Overall Survival 63 months (1 – 105) Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011 5y surv – 52.7%
  • 34. www.CirurgiaOnline.com.br Results • Blood Transfusion x Survival – No: 19 patients (68%) - SV 74 months – Yes: 09 patients (32%) - SV 21 months • Mean 1200 ml ( 600-1800 ml) Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 35. www.CirurgiaOnline.com.br Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011 P= 0.001
  • 36. www.CirurgiaOnline.com.br Results • Recurrence - 76.5% R0 patients recurred (50% liver) -7 patients 2nd resection -4 patients 3rd resection -2 patients 4th resection Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 37. www.CirurgiaOnline.com.br Results • Repeat Resection Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011 P= 0.060Repeat Resection Median Yes 66.33 No 33.23 Overall 62.73
  • 38. www.CirurgiaOnline.com.br Results • Treatment • Neoadjuvant Radiotherapy 1 case • Neoadjuvant Chemo 5 cases • Adjuvant Radiotherapy 1 case • Adjuvant Chemo 15 cases • Adjuvant Radio + Chemo 3 cases • No Other treatment 8 cases Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011
  • 39. www.CirurgiaOnline.com.br Results • Neo or Adjuvant treatment X Survival (R0) Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011 P= 0.212 P= 0.668
  • 40. www.CirurgiaOnline.com.br Results • OS Neo or Adjuvant treatment X Survival (All patients) Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011 P= 0.703
  • 41. www.CirurgiaOnline.com.br Results • OS Neo or Adjuvant treatment X Survival (GIST) Analysis of the hepatectomies for sarcoma metastases 15 years experience of NCI Brazil 1996-2011 P= 0.051 Adv. Treat. Median GIST - Others Sarcomas 33.23 Overall 62.73
  • 43. www.CirurgiaOnline.com.br Conclusion Although only 8 patients are alive at the moment ( 6 GIST) and 2 are disease free Imatinib - 2003 The Complete Resection and Repeat Resection should improve survival and is recommended. Blood Transfusion should be Avoided HEPATIC METASTASES OF SARCOMA
  • 44. www.CirurgiaOnline.com.br Good news Sir, We achieve a complete resection !