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Hanno Matthaei, MD; Andreas Krieg, MD; Moritz Schmelzle, MD; Edwin Boelke, MD; Christopher Poremba, MD; Xavier Rogiers, MD; Wolfram Trudo Knoefel, MD; Matthias Peiper, MD

Arch Surg. 2009;144(4):339-344.

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.

Author Affiliations: Klinik für Allgemein-, Viszeral-, und Kinderchirurgie (Drs Matthaei, Krieg, Schmelzle, Knoefel, and Peiper), Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie (Dr Boelke), and Institut für Pathologie (Dr Poremba), Universitätsklinikum Düsseldorf, Düsseldorf, and Klinik und Poliklinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf (Dr Rogiers), Germany.

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Arch Surg. 2009;144(4):344.
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