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Long-term Survival After Surgery for Primary Hepatic Sarcoma in Adults—Invited Critique

Long-term Survival After Surgery for Primary Hepatic Sarcoma in Adults—Invited Critique As we enter the 21st century, there is no question that liver resections will be done more frequently, more safely, and by more surgeons than ever before. New techniques for resection are being introduced, so that blood loss and complications are at an all-time low. The accepted mortality for liver resection used to be around 5%, but now the large centers are doing major resections with mortalities of less than 2%. These conditions lead surgeons to be more liberal as to patient selection for hepatic resection. This study about primary hepatic sarcomas is an example of a clear indication for liver resection as a treatment for a condition that many once thought was incurable. Primary hepatic sarcomas are very rare tumors, so there are no real experts on this pathology. Matthaei et al were able to collect 22 patients in 20 years who underwent a resection as treatment for primary hepatic sarcoma. A recent study in 2007 from Memorial Sloan-Kettering Cancer Center, one of the largest cancer centers in the United States, reviewed the same pathology seen at their institution over a period of 24 years and only had 16 patients who underwent resection. This is indeed a rare tumor. The main value of reports on very rare tumors is to compile data to lead to more empirical factors on how to treat such patients. Matthaei et al show us in their report that patients with primary hepatic sarcoma should have a resection, because this gives a decent chance for survival. Both this study and the Memorial Sloan-Kettering Cancer Center study had 5-year survival rates of more than 60% for patients with R0 resections, that is, resections with pathologically negative margins. The Matthaei et al report actually had a 77% 5-year survival rate for their 18 patients who had R0 resections. The clear take-home message is that liver resections for solitary masses are a good treatment with excellent results for this serious condition. This report could not do any subset analyses on types of sarcomas and prognosis. Although most of their patients had leiomyosarcomas (approximately 32%), the other histologies were varied. Matthaei et al did not report whether these sarcomas were tested for c-Kit, that is, whether they were gastrointestinal stromal tumors. But even if these tumors were gastrointestinal stromal tumors, it would still be better to resect them and then follow with adjuvant imatinib mesylate therapy. Whenever a study has small patient numbers, the performance of a multivariate analysis of prognostic factors is usually of little value. However, both the Matthaei et al report and the Memorial Sloan-Kettering Cancer Center study found that angiosarcomas seem to have a worse prognosis than all the other types of sarcomas. There were 5 patients with angiosarcomas in the Matthaei et al report and 3 patients in the Memorial Sloan-Kettering Cancer Center report, so these are very limited data. The important message is that surgical resection of tumors of the liver, no matter what their histology, especially resection with clear margins, can give patients a good chance at control of their disease and should be used. Because of the rareness of these tumors, it would probably be wise for these patients to go to a large cancer center where there may be some experience as to the multimodality treatment of these tumors. Correspondence: Dr Kemeny, Cancer Center of Queens, Queens Hospital Center, 82-68 164th St, Jamaica, NY 11432 (kemenym@nychhc.org). Financial Disclosure: None reported. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Long-term Survival After Surgery for Primary Hepatic Sarcoma in Adults—Invited Critique

Archives of Surgery , Volume 144 (4) – Apr 20, 2009

Long-term Survival After Surgery for Primary Hepatic Sarcoma in Adults—Invited Critique

Abstract

As we enter the 21st century, there is no question that liver resections will be done more frequently, more safely, and by more surgeons than ever before. New techniques for resection are being introduced, so that blood loss and complications are at an all-time low. The accepted mortality for liver resection used to be around 5%, but now the large centers are doing major resections with mortalities of less than 2%. These conditions lead surgeons to be more liberal as to patient selection for...
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Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.2009.31
Publisher site
See Article on Publisher Site

Abstract

As we enter the 21st century, there is no question that liver resections will be done more frequently, more safely, and by more surgeons than ever before. New techniques for resection are being introduced, so that blood loss and complications are at an all-time low. The accepted mortality for liver resection used to be around 5%, but now the large centers are doing major resections with mortalities of less than 2%. These conditions lead surgeons to be more liberal as to patient selection for hepatic resection. This study about primary hepatic sarcomas is an example of a clear indication for liver resection as a treatment for a condition that many once thought was incurable. Primary hepatic sarcomas are very rare tumors, so there are no real experts on this pathology. Matthaei et al were able to collect 22 patients in 20 years who underwent a resection as treatment for primary hepatic sarcoma. A recent study in 2007 from Memorial Sloan-Kettering Cancer Center, one of the largest cancer centers in the United States, reviewed the same pathology seen at their institution over a period of 24 years and only had 16 patients who underwent resection. This is indeed a rare tumor. The main value of reports on very rare tumors is to compile data to lead to more empirical factors on how to treat such patients. Matthaei et al show us in their report that patients with primary hepatic sarcoma should have a resection, because this gives a decent chance for survival. Both this study and the Memorial Sloan-Kettering Cancer Center study had 5-year survival rates of more than 60% for patients with R0 resections, that is, resections with pathologically negative margins. The Matthaei et al report actually had a 77% 5-year survival rate for their 18 patients who had R0 resections. The clear take-home message is that liver resections for solitary masses are a good treatment with excellent results for this serious condition. This report could not do any subset analyses on types of sarcomas and prognosis. Although most of their patients had leiomyosarcomas (approximately 32%), the other histologies were varied. Matthaei et al did not report whether these sarcomas were tested for c-Kit, that is, whether they were gastrointestinal stromal tumors. But even if these tumors were gastrointestinal stromal tumors, it would still be better to resect them and then follow with adjuvant imatinib mesylate therapy. Whenever a study has small patient numbers, the performance of a multivariate analysis of prognostic factors is usually of little value. However, both the Matthaei et al report and the Memorial Sloan-Kettering Cancer Center study found that angiosarcomas seem to have a worse prognosis than all the other types of sarcomas. There were 5 patients with angiosarcomas in the Matthaei et al report and 3 patients in the Memorial Sloan-Kettering Cancer Center report, so these are very limited data. The important message is that surgical resection of tumors of the liver, no matter what their histology, especially resection with clear margins, can give patients a good chance at control of their disease and should be used. Because of the rareness of these tumors, it would probably be wise for these patients to go to a large cancer center where there may be some experience as to the multimodality treatment of these tumors. Correspondence: Dr Kemeny, Cancer Center of Queens, Queens Hospital Center, 82-68 164th St, Jamaica, NY 11432 (kemenym@nychhc.org). Financial Disclosure: None reported.

Journal

Archives of SurgeryAmerican Medical Association

Published: Apr 20, 2009

Keywords: sarcoma,surgical procedures, operative,surgery specialty

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