Does Hepatic Metastasectomy for Breast Cancer Oligo-Metastasis to the Liver Offer Survival Advantage? Systematic Review and Meta-Analysis

Abstract

Abstract Background: The impact of liver resection on survival in patients with hepatic metastasis from breast cancer has remained a controversial topic, with multiple studies reporting conflicting results. Objective: We perform this meta-analysis comparing metastasectomy to systemic therapy in terms of survival outcomes in cases of hepatic oligo-metastasis from breast cancer. Materials and Methods: A systematic search of PubMed, Embase, and Cochrane Library was conducted for relevant studies. The search terms used included “Breast Neoplasms,” “Liver,” hepatic” “Metastasis” “Hepatectomy,” “Metastasectomy” “resection,” and “surgery.” The primary outcome was overall survival (OS). Only studies published in English and studies that compared OS between patients that had metastasectomy and those that received systemic therapy were included. Results: Thirteen studies were included in the meta-analysis. The one year overall survival of patients who had surgery is superior to those who received systemic therapy only, with a risk ratio (RR) of 7.59 and P value of <0.00001. There is also a superior overall survival at 3 years after metastasectomy when compared with patients that received systematic therapy (RR = 2.83, P = 0.005). Five years is also superior, with RR of 2.78 and P value of 0.005. Conclusion: Hepatic metastasectomy in combination with systemic therapy is superior to systemic therapy alone in patients with breast cancer and oligo-metastasis of the liver.