1. 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

2. 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

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

4. 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.

5. Patterns of spread

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

9. 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.

10. Results – Cervical cancer liver metastases
Between 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

11. 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

12. 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

13. 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.

14. 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 years).
All cases were diagnosed with metachronous lesions after a median disease free survival of 12 months (range months).

15. 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

16. 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).

17. 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.

18. Thank you!