Results of a single-center experience with resection and ablation for sarcoma metastatic to the liver

Hypothesis: A subset of patients with sarcoma liver metastasis may benefit from hepatic resection and/or ablation. Design: Retrospective review of prospectively collected cancer center database records. Patients and Methods: Sixty-six patients who underwent hepatic resection and/or open radio-frequency ablation of metastatic sarcoma between July 1, 1996, and April 30, 2005, were identified from the database. Clinicopathologic, operative, recurrence, and long-term survival data were analyzed. Results: The primary sarcoma site was the abdomen or retroperitoneum (n=22), stomach (n=18), small or large bowel (n=17), pelvis (n=4), uterus (n=3), or other (n=2). Tumor pathologic types included gastrointestinal stromal tumor (n=36), leiomyosarcoma (n=18), and sarcoma not otherwise classified (n=12). Thirty-five patients underwent resection, 18 underwent resection plus radiofrequency ablation, and 13 underwent radiofrequency ablation only. With a median follow-up of 35.8 months, 44 patients (66.7%) had recurrence (intrahepatic only, n=16; extrahepatic only, n=11; both, n=17). Treatment with radiofrequency ablation (either alone or combined with resection) (P=.002) and lack of adjuvant chemotherapy (P=.01) predicted shorter disease-free survival. The 1-, 3-, and 5-year overall survival rates were 91.2%, 65.4%, and 27.1%, respectively. Patients with gastrointestinal stromal tumor who were treated with adjuvant imatinib mesylate had the longest median survival (not reached) (P=.003). Conclusions: Long-term survival can be achieved following surgical treatment of sarcoma liver metastasis, especially in patients with gastrointestinal stromal tumor. Patients with sarcoma liver metastasis should be evaluated by a multidisciplinary team, as recurrence is common and adjuvant therapy may prolong survival.