Liver surgery for metachronous hepatic metastases with uterine body and uterine cervix origin – a single center experience Nicolae Bacalbasa (1), Irina Balescu (2), Simona Dima (3), Vladislav Brasoveanu (3), Irinel Popescu (1,3) Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Ponderas Hospital, Bucharest, Romania Dan Setlacec Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania

Uterine body and uterine cervix cancer – the magnitude of the problem In 2010 the incidence of uterine body and cervical cancer worldwide reached 473,000 newly diagnosed cases In the same year 225,000 women were dead of disease

Cervical cancer – the magnitude of the problem Estimated incidence from cervical cancer in women, 2012 Estimated mortality from cervical cancer in women, 2012

Cervical cancer – patterns of spread The main patterns of spread consist of: Contiguity– vagina, parameters, uterine body Lymphatic spread: - positive lymph nodes increase proportionally with FIGO stage: Positive pelvic lymph nodes: 12-22% in stage Ib 10-27% in stage IIa 34-43% in stage IIb Hematogenous route – leading to hepatic, pulmonary bone metastases <3% of cases.

Patterns of spread

Aims To demonstrate the effectiveness of liver resection in metachronous liver metastases from cervical and uterine body cancer

Material and methods Between January 2002 and April 2014, 19 patients with metachronous liver metastases from cervical cancer or uterine body cancer were treated surgically in Fundeni Clinical Hospital.

Results – Cervical cancer liver metastases Between 2002-2014 13 patients were submitted to surgery for cervical cancer liver metastases The mean age at the moment of cervical cancer diagnosis was 50.4 years Disease free survival between surgery for cervical cancer and re-apparition of symptoms was 20 months

Results – Cervical cancer liver metastases Characteristics No. of cases No. of liver metastases Unique 11 Multiple 2 Association of pelvic recurrence 3 Type of liver resection Major hepatectomy 4 Minor hepatectomy 9

Results – Cervical cancer liver metastases Postoperative morbidity No. of cases Management 1. Related to liver surgery Biliary fistula 1 (7.6%) Conservative, the patient was discharged the 11th postop. day Pleural effusion Conservative, the patient was discharged the 18th postop. day 2. Related to other associated resection Urinary fistula Re-operation, MSOF, death occurred in the 21th postop. day

Cervical cancer liver metastases – short term and long term outcomes 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). Long term outcomes: the median survival after liver resection was 17,9 months.

Results – Uterine body liver metastases A number of 6 patients were submitted to liver resection for uterine cancer hepatic metastases. The mean age at the moment of diagnosis of liver metastases was 58 years (range 46-65 years). All cases were diagnosed with metachronous lesions after a median disease free survival of 12 months (range 10-22 months).

Results – Uterine body liver metastases Patients’ characteristics at the time of primary diagnosis No. of cases Initial stage II 1 III 5 Initial performed surgery Total hysterectomy with bilateral adnexectomy 6 Pelvic lymph node dissection 4 Para-aortic lymph node dissection 2 Histopathological studies: Endometrial adenocarcinoma Leiomyosarcoma Adjuvant chemotherapy Adjuvant radiation therapy Type of lesion: Metachronous Type of liver resection: Major Minor Postoperative complications: Febrile syndrome for unknown origin Results – Uterine body liver metastases

Uterine corpus liver metastases – short term and long term outcomes No complication related to liver surgery! Mean postoperative hospital in stay: 8 days, range (6-15 days) The median overall survival after liver resection was 22 months (range 8-29 months).

Conclusion Liver resection for metachronous hepatic metastases from uterine cervix or uterine body cancer is safe and effective In selected cases a significant benefit in terms of survival is expected.

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