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Original Article
April 20, 2009

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

Author Affiliations

Author Affiliations: Klinik f[[uuml]]r Allgemein-, Viszeral-, und Kinderchirurgie (Drs Matthaei, Krieg, Schmelzle, Knoefel, and Peiper), Klinik und Poliklinik f[[uuml]]r Strahlentherapie und Radiologische Onkologie (Dr Boelke), and Institut f[[uuml]]r Pathologie (Dr Poremba), Universit[[auml]]tsklinikum D[[uuml]]sseldorf, D[[uuml]]sseldorf, and Klinik und Poliklinik f[[uuml]]r Hepatobili[[auml]]re Chirurgie und Transplantationschirurgie, Universit[[auml]]tsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf (Dr Rogiers), Germany.

Arch Surg. 2009;144(4):339-344. doi:10.1001/archsurg.2009.30

Hypothesis  Patients with primary hepatic sarcomas benefit from resection, with possible long-term cure.

Design  Retrospective and prospective cohort study.

Setting  University hospitals of Hamburg-Eppendorf and Düsseldorf, Germany.

Patients  Between 1985 and 2006, 22 patients (8 men and 14 women; median age at initial diagnosis, 54 years [range, 19-80 years]) were surgically treated for primary hepatic sarcomas.

Intervention  Tumor resection with curative intent ranging from nonanatomical resection to liver transplant.

Main Outcome Measures  Effects on overall survival were analyzed using the log-rank test.

Results  The majority of tumors were more than 5 cm (n = 19), with a median tumor size of 7 cm (range, 4-14 cm); of intermediate differentiation (G2; n = 15); and classified as leiomyosarcoma (n = 7). Ten patients received a hemihepatectomy. In 4 patients, a bisegmentectomy was performed and in 2 patients, a segmentectomy, while 4 patients received a nonanatomical resection. Liver transplant was performed in 2 patients. In 18 patients, complete tumor resection (R0) was achieved. Perioperative mortality was 0%. Median follow-up was 88 months (range, 6-246 months). Local recurrence occurred in 6 patients. Distant metastases were diagnosed in 10 patients, predominantly in the lung (n = 6). The 5-year survival after surgery was 65%, with 41% of the patients living more than 10 years without disease. Patients with angiosarcoma had a poor prognosis (P = .03).

Conclusions  Although primary hepatic sarcoma is a rare malignant tumor, no standard treatment is established. A long-term survival is possible after complete tumor resection in a preselected population with early-stage disease.