Treating Breast Cancer That Has Spread to the Liver: A Complete Guide to Surgery and Radiofrequency Ablation

Table of Contents

• Key Points
• Background: Why This Research Matters
• How This Review Was Conducted
• The Patients and Their Tumors
• Results of Liver Surgery
• Which Factors Predict a Better Outcome?
• Oligometastatic Disease and Repeat Surgery
• Surgery Plus Drug Therapy vs. Drug Therapy Alone
• Risks, Complications, and Hospital Stay After Surgery
• Radiofrequency Ablation and Other Local Treatments
• Cost-Effectiveness of Liver Surgery
• Future Directions: Combining Treatments
• What This Means for Patients
• Limitations: What This Review Cannot Prove
• Practical Recommendations
• Frequently Asked Questions
• Source Information

Key Points

• In pooled studies of 605 women, median survival after liver surgery for breast cancer metastases was 39.5 months, and 38% were alive at 5 years.
• Radiofrequency ablation produced a median survival of 32 months and 5-year survival of 27%, with about 2 days in hospital and lower complication rates.
• Favorable features included hormone receptor–positive primary tumors, complete removal (R0), no cancer outside the liver, and small or single liver tumors.
• No randomized trial has compared liver surgery with drug therapy alone; patients chosen for surgery tend to be healthier, so results must be interpreted carefully.
• Postoperative death after liver surgery was 0% to 5%; complications occurred in about 28%, and the median hospital stay was 8.5 days.

Background: Why This Research Matters

Breast cancer is the most frequently diagnosed cancer in women worldwide. In Japan, 76,257 breast cancer cases were diagnosed in 2014, according to the Cancer Information Service at the National Cancer Center of Japan. In the United States, 266,120 breast cancer cases were diagnosed in 2018, and 40,920 women died of the disease that year.

When breast cancer is found early, patients generally do well. But roughly 20% to 30% of all women diagnosed with breast cancer — about 1 in 5 to 1 in 3 — develop metastatic disease (cancer that has spread to distant organs). The leading sites of distant spread are bone (41.1%), lung (22.4%), liver (7.3%), and brain (7.3%).

The liver is not the most common first site of spread, but it is an important one. BCLM (breast cancer liver metastases) is the first site of metastatic disease in 5% to 20% of patients. About half of all patients develop liver metastases at some point during their illness.

Metastatic breast cancer, apart from local recurrence (cancer returning only at the original site), is considered incurable. Ten-year overall survival (OS, the proportion of patients still alive 10 years later) among patients given systemic therapy (drug treatment that travels through the bloodstream) is about 5%, roughly 1 in 20. Only 2% to 3% of patients stay in complete remission for more than 20 years.

Drug therapy has improved steadily

Systemic treatments have gotten better over time, and this has improved progression-free survival (PFS, time before the cancer grows again) and overall survival. Since the 1990s, chemotherapy has improved outcomes for patients with metastatic breast cancer. From the 2000s onward, newer options have appeared, including:

• Targeted anti-HER2 agents (drugs that block a protein called human epidermal growth factor receptor type 2), such as trastuzumab, pertuzumab, and T-DM1
• mTOR inhibitors (drugs that block a growth-signaling protein called mTOR)
• CDK4/6 inhibitors combined with hormonal therapy (drugs that interrupt how cancer cells divide)
• Immune checkpoint inhibitors (drugs that help the immune system attack cancer), such as atezolizumab, a humanized monoclonal anti-PD-L1 antibody
• PARP inhibitors for BRCA-positive, HER2-negative metastatic breast cancer

Because so many drug options exist, surgery for liver metastases has long been viewed as too aggressive for many patients. Liver metastases were historically treated as incurable, with palliative care (treatment to relieve symptoms rather than cure) aimed at improving quality of life and prolonging survival.

That view is shifting. A growing body of evidence suggests that removing liver metastases, or destroying them with local therapies, may do two things. First, it can reveal important tissue information. That information is the tumor subtype, including estrogen receptor, progesterone receptor, and HER2 status of the metastatic tumor. Second, it may extend survival. Since 2000, many studies have examined surgical treatment of BCLM. Those studies tended to be small, and they used different criteria for choosing which patients had surgery. Still, some clinical benefits emerged. More recent results suggest that patients with solitary liver metastases or "oligo-metastatic" breast cancer (a small number of metastases) may benefit most from local therapies. This review examined the indications for and outcomes of liver resection and other local treatments for BCLM.

How This Review Was Conducted

The authors searched the PubMed database using the terms "breast cancer," "liver metastases," and "surgery." Drug therapy has made major advances and surgical technique has improved. Because of these advances, the authors focused on major studies published after 2010. This means the review covers roughly the two decades from 2000 to the present.

For liver resection (surgery to remove part of the liver), the final analysis included 11 series totaling 605 patients. For radiofrequency ablation, the review covered 7 reports — described in the article's abstract as 266 patients and in the body of the text as 225 patients. The authors summarized primary tumor characteristics, clinical outcomes, and prognostic factors (factors that predict outcome) across these studies.

The Patients and Their Tumors

The 11 surgical series were published between 2012 and 2018. In nearly all of them, the study period started around or after 2000, though two series began in the 1980s and each included more than 100 patients. The median (midpoint) number of patients per study was 43, with a range of 12 to 131.

Study designs varied. Six studies were prospective, meaning patients were followed forward in time. Two were retrospective, looking back at existing records. Three were case-control studies, comparing patients who had surgery with similar patients who did not. Nine were single-center analyses and two were multicenter analyses. Five series consisted of patients who had undergone radiofrequency ablation.

Primary tumor features

The most common tumor type was invasive ductal carcinoma, which made up a median of 83% of cases (range 12% to 92%).

• Tumor stage (T) and lymph node stage (N) were reported in 7 series. A T1 or T2 primary tumor (relatively small, early-stage tumors) was present in a median of 83% of cases (range 54% to 92%).
• Lymph node involvement: about half of the total patients (52.5%, range 28% to 71%) had cancer in their lymph nodes.
• M status (whether distant metastases were present when breast cancer was first diagnosed) was reported in only 3 series. The proportions of patients who already had distant metastases at the time of their original diagnosis were 0%, 10%, and 32%.
• Hormone receptor status was reported in 9 studies. Median estrogen receptor–positive rates were 75% (range 45% to 82%), and median progesterone receptor–positive rates were 55% (range 9% to 82%).
• HER2 status was reported in 7 studies. HER2 was positive in 39% of patients (range 14% to 55%) in those studies.

Results of Liver Surgery

Overall, the numbers after liver resection were substantially better than what is typically expected with drug therapy alone in metastatic breast cancer.

• Time to developing liver metastases: a median of 34 months (range 20 to 60 months) across 8 studies.
• Largest liver tumor size: a median of 4 cm (range 1.8 to 5.2 cm) across 8 reports.
• Cancer outside the liver (extrahepatic metastases, EHM): a median of 26.5% of patients (range 7% to 45%).
• Major resection (removing three or more liver segments): performed in 47% of patients (259 of 556), with a median of 42.5% per study (range 29% to 69%).
• Complete surgical removal (R0 resection, meaning no cancer cells visible at the cut edge under a microscope): reported in 9 studies, with a median of 86% (range 53% to 92%).
• Cancer recurrence: 42.5% of patients (153 of 360) had the cancer return, with a median recurrence rate per study of 40% (range 14% to 52%).
• Median follow-up: 55 months (range 22 to 69 months).

Survival after surgery

Median disease-free survival (DFS, time alive without the cancer returning) was 23 months (range 14 to 29 months). Median overall survival was 39.5 months (range 26 to 82 months).

Survival at the standard checkpoints was:

• 1 year: 89.5% (range 80% to 100%)
• 3 years: 70% (range 46% to 81%)
• 5 years: 38% (range 11% to 69%) — roughly 4 patients in 10

The authors caution that these studies had different numbers of patients, different clinical features, different selection criteria, and different designs. The data must therefore be interpreted carefully.

Regarding drug treatment before or after surgery, 6 articles described systemic therapies. These included hormonal treatment with or without chemotherapy (doxorubicin, taxol, capecitabine, gemcitabine) and/or trastuzumab or lapatinib. Importantly, none of the patients in this review had received the newer targeted therapies such as pertuzumab, CDK4/6 inhibitors, or immune checkpoint inhibitors.

Which Factors Predict a Better Outcome?

Several factors consistently predicted who did better after surgery to remove liver metastases.

Hormone receptor–positive primary breast cancer was the most frequently identified favorable factor. Seven studies linked it to better overall survival. Three used multivariate analysis, a statistical method that adjusts for other factors at the same time. Four used univariate analysis, looking at one factor at a time.

Complete removal of tumor (R0 resection) was associated with better overall survival in two multivariate and two univariate analyses.

Extrahepatic metastases (cancer outside the liver) were linked to poorer overall survival in three multivariate analyses — patients whose cancer was confined to the liver did better.

Smaller liver tumors predicted better results. Liver metastases smaller than 3 cm were associated with better overall survival, while tumors 3.5 cm or larger were linked to poorer progression-free survival, according to three multivariate analyses. A univariate analysis also showed tumor size mattered.

Fewer tumors also mattered. One multivariate and one univariate analysis found that patients with solitary (single) liver metastases had better overall survival, and the number of metastases was linked to both DFS and OS.

Longer time before the cancer returned was favorable. Patients whose disease-free interval was 4 years or less had poorer OS and PFS in multivariate analysis, and those with DFS under 2 years had poorer OS in univariate analysis.

Response to drug therapy before surgery mattered too. Tumors were evaluated with RECIST criteria, the standard rules for measuring how tumors respond to treatment. No response to pre-operative systemic therapy was associated with progressive disease and poorer overall survival. One study reported that patients who had a partial response to chemotherapy had a median survival of nearly 80 months. This compared with approximately 30 months for patients whose response was less than partial — nearly a threefold difference.

Other primary tumor characteristics — T stage, lymph node metastases, and tumor grade (how abnormal the cells look) — also influenced overall survival. Age appeared in the picture as well. One analysis found better outcomes in patients under 50, and another found better outcomes in patients over 50. This suggests that age alone is not a reliable guide.

Oligometastatic Disease and Repeat Surgery

The 4th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4) define oligometastatic disease. The definition is "low volume metastatic disease with limited number and size of metastatic lesions (up to 5 and not necessarily in the same organ)." Such disease is potentially amenable for local treatment. Local treatment is aimed at achieving a complete remission status.

In colorectal cancer, removing liver metastases is a well-established treatment. For breast cancer liver metastases, that approach remains controversial, even when only a few metastases are present.

More than 50% of the patients in the reports reviewed here had solitary liver metastases. One study noted significantly more long-term survivors among patients with solitary tumors, with survival reaching 60 months or more in some cases.

One research group reported a series of patients who underwent "repeat hepatectomy" (a second liver operation). They compared a single-hepatectomy group (120 patients) with a repeat-hepatectomy group (19 patients).

• Solitary liver metastases: 39% in the single-surgery group vs. 53% in the repeat-surgery group.
• Survival after the first operation: patients who went on to have repeat surgery lived longer than those who had only one operation — 95% and 84% vs. 50% and 38% at 3 and 5 years (P=0.002).
• Median survival: 35 months vs. 100 months.
• Number of tumors: patients with a single liver metastasis at first surgery had 3- and 5-year overall survival rates of 76% and 76%, compared with 51% and 17% in patients with multiple metastases (P=0.023).

Factors predicting a better outcome after repeat hepatectomy included a time interval of more than 2 years between breast cancer diagnosis and the first liver operation. Other factors were a limited (smaller) resection, solitary metastases, positive progesterone receptor status, and chemotherapy given after the repeat operation. The authors concluded that repeat hepatectomy is potentially curative when combined with systemic therapy.

Another study looked specifically at resection of isolated liver metastases. Among 29 female patients, 16 (55%) had one liver metastasis and 6 (21%) had two. Median time from breast cancer to diagnosis of liver metastases was 55 months (range 1 to 77 months). The 1-year survival rate was 86% in patients who had surgery and 37.5% in those who did not. Complete removal (R0), fewer liver metastases, and a longer interval before the liver metastases appeared were significant prognostic factors.

Recent studies show that subgroups of these patients with oligometastatic disease benefit from additional local or locoregional treatment. These patients have improved survival after complete (R0) removal of liver metastases compared with systemic treatment alone.

Surgery Plus Drug Therapy vs. Drug Therapy Alone

To date, no prospective randomized trial (the strongest type of study, in which patients are assigned by chance to different treatments) has examined removal of breast cancer liver metastases. Instead, researchers have used case-control studies, in which surgically treated patients are compared with similar patients who received only drug therapy.

In one such study, 51 patients with BCLM were individually matched with patients receiving systemic treatment only. None had more than 4 liver metastases, and most had fewer than 4. Patients were matched for age, year of breast cancer diagnosis, time to metastases, TNM stage, hormone receptor status, and tumor pathology. The 3-year survival rates were 80.7% in the surgically treated group and 50.9% in the non-surgically treated group (P<0.0001).

A second matched comparison used data from European patients. Matching was based on age, decade of diagnosis, time to metastases, maximum size of metastases, single vs. multiple tumors, chemotherapy, and hormonal or targeted therapy after diagnosis. Propensity score matching (a statistical technique that creates groups with similar characteristics and a similar likelihood of having surgery) was used.

• Median overall survival: 82 months with surgery plus systemic therapy vs. 31 months with systemic therapy alone (P<0.001).
• 3-year overall survival: 81% vs. 69%.
• 5-year overall survival: 33% vs. 24%.
• Risk of death: patients treated with surgery plus systemic therapy were less likely to die than those given systemic therapy alone (hazard ratio 0.28; 95% confidence interval 0.15 to 0.52; P<0.001). This means the risk of death was about 72% lower in the surgery group.

In plain terms, patients who received systemic therapy combined with liver surgery lived more than twice as long as those given systemic therapy alone.

A third case-control study compared 69 patients who had surgery and/or ablation with 98 patients who received medical treatment only, with a median follow-up of 73 months. Patients in the surgical group tended to have estrogen receptor–positive tumors and to have received adjuvant chemotherapy and radiotherapy for their original breast tumor. Their liver tumor volume was smaller, and the time to diagnosis of liver metastases was significantly longer (53 months vs. 30 months) in the surgical group.

In this study, there was no significant difference in overall survival between the surgical and systemic therapy groups (median 50 vs. 45 months; 5-year survival 38% vs. 39%). However, the surgical treatment group had a median recurrence-free interval of 28.5 months, and 10 patients (15%) remained free of recurrence after 5 years. The authors concluded that surgical treatment of BCLM might be applicable in carefully selected patients, with the goal of minimizing or avoiding systemic chemotherapy.

Risks, Complications, and Hospital Stay After Surgery

Postoperative mortality (death within the period right after surgery) was 0% in five reports, 2% in one report, and 5% in one report. The median postoperative morbidity (rate of complications) was 28%, with a range of 18% to 42%.

Major complications developed in 3.5% to 12% of cases and included:

• Multiple organ failure
• Biliary leakage (bile leaking from the liver's bile ducts)
• Biliary fistula (an abnormal connection involving the bile ducts)
• Infected intra-abdominal fluid collections, with or without the need for drainage
• Need for percutaneous drainage (draining fluid through the skin)

The median hospital stay after liver surgery was 8.5 days, with a range of 6 to 11 days.

Radiofrequency Ablation and Other Local Treatments

Several local treatments are available for breast cancer liver metastases. These include radiofrequency ablation (RFA, which uses heat to destroy tumors) and cryoablation (CRA, which uses extreme cold). They also include stereotactic radiofrequency ablation (SRFA), brachytherapy (internal radiation), and transarterial chemoembolization (TACE, which delivers chemotherapy directly into the liver's blood supply).

RFA is particularly safe and effective and has been widely reported for BCLM. The RFA portion of this review covered 7 reports published from 2007 to 2018, with studies conducted between 1996 and 2015.

• Number of patients: median 43 per study (range 12 to 69); the abstract reports 266 patients in total, while the body of the review states 225.
• Number of treated tumors: median 87 per study (range 13 to 135), averaging 1.9 tumors per patient (range 1.1 to 2.1).
• Guidance method: two series used computed tomography–guided RFA; five used ultrasound-guided RFA.
• Mean size of metastases: 2.4 cm (range 2 to 3.5 cm).
• Extrahepatic metastases: a mean of 36% of patients (reported as up to 40% to 83% across series).
• Complete response rate: median 86% (range 67% to 97%).
• Solitary liver metastasis: median 55.5% of patients (range 26% to 62%).

Survival after RFA

Median follow-up in these reports was 24 months. Median disease-free survival was 11 months, median overall survival was 32 months, and the 3- and 5-year overall survival rates were 43% and 27% — about 3 in 10 patients alive at 5 years.

Complication rates with RFA were lower than with surgical resection. Four studies reported major complication rates of 0%. The others reported rates of 1.1%, 2.3%, and 6.9%. The complications included severe intrahepatic bleeding (bleeding inside the liver) and injury to the bile duct. They also included thrombosis (clotting) of the portal branch, sepsis (a severe whole-body infection response), and cholecystitis (inflammation of the gallbladder). The median hospitalization period was 2 days (range 1 to 5 days).

Repeat RFA and tumor size

One report described a patient who underwent three RFA sessions, achieving local control for 47 months. Another study found local tumor progression in 15 of 111 metastases at 3 months of follow-up, and five patients in that study received repeat RFA.

Tumor size matters with RFA. One group reported that a liver metastasis larger than 2.5 cm was linked to poor outcomes. Another reported on 69 patients with 135 liver metastases: local tumor progression occurred in 8 patients, 4 to 8 months after RFA. The rates of local progression according to the margin of healthy tissue around the treated tumor were:

• 0 to 5 mm margin: 38.9% progressed
• More than 5 to 10 mm margin: 3.6% progressed
• More than 10 mm margin: 0% progressed

Among the 8 patients whose tumors progressed, 7 required repeat RFA.

How RFA and surgery compare

The clinical features that make a patient a good candidate for RFA differ from those favoring surgery. RFA is typically used for smaller tumors and in patients with a higher rate of cancer outside the liver: an average tumor size of 2.4 cm vs. 4.0 cm for surgery, and 46% vs. 27% with extrahepatic metastases. The merits of RFA are its high technical success rate, low rate of complications, short hospital stay, and the fact that it can be repeated.

Cost-Effectiveness of Liver Surgery

Cost is an important consideration in cancer care. One research group evaluated the cost-effectiveness of liver resection using a Markov model. A Markov model is a mathematical model that simulates how patients move between health states over time. The group combined this with Monte-Carlo simulation, a method that tests many possible scenarios at once. They compared three groups:

1. Liver resection followed by conventional systemic therapy after surgery
2. Conventional systemic therapy alone
3. Newer targeted therapy alone

The authors concluded that liver resection is potentially more cost-effective than systemic therapy alone. This is especially true in patients who are positive for the estrogen receptor and/or who are receiving newer systemic therapies.

Future Directions: Combining Treatments

For RFA, combining the procedure with other therapies such as immune checkpoint inhibitors may strengthen the body's antitumor immune response. Both radiotherapy and RFA combined with immune checkpoint inhibitors can trigger a distant antitumor response — an effect in which treating one tumor causes tumors elsewhere in the body to shrink. This is called an abscopal immune-priming effect (a "priming" of the immune system that reaches beyond the treated site). Research in this area is still developing.

What This Means for Patients

This review suggests that removing or ablating breast cancer liver metastases can offer meaningful survival for carefully selected patients. The median overall survival after surgery was 39.5 months, and 38% of patients — about 4 in 10 — were alive at 5 years. With systemic therapy alone, 10-year survival is about 5%.

The most favorable profile is a patient whose original breast cancer was hormone receptor–positive. The patient's liver tumors are small and solitary, and the cancer has not spread outside the liver. The surgeon can remove all visible disease with clear margins. Patients with these features had the best outcomes across multiple analyses.

RFA offers a less invasive alternative with a shorter hospital stay — a median of 2 days versus 8.5 days for surgery — and lower complication rates. However, survival after RFA was shorter: a median of 32 months and a 5-year survival of 27%. RFA's advantage is that it can be repeated if new tumors appear.

Liver surgery also provides tissue for testing the metastatic tumor's receptor status (estrogen receptor, progesterone receptor, and HER2), which can guide later drug treatment choices. That is a benefit beyond survival alone.

Limitations: What This Review Cannot Prove

Several important caveats apply to these findings. First, there have been no prospective randomized trials of liver surgery for breast cancer liver metastases. Without randomization, doctors cannot be certain that surgery itself caused the longer survival. Patients chosen for surgery tend to be healthier and to have less extensive cancer to begin with.

Second, the studies in this review varied widely. They enrolled different numbers of patients (12 to 131), used different selection criteria, and had different designs and follow-up periods. The authors state plainly that the data must be carefully interpreted for these reasons.

Third, surgical patients in the case-control studies were matched but not randomized, and matching can never account for every difference between groups.

Fourth, none of the patients in this review received the newest drug therapies, such as pertuzumab, CDK4/6 inhibitors, or immune checkpoint inhibitors. Since those drugs improve outcomes on their own, the relative benefit of surgery may differ in patients treated today.

Fifth, the RFA data are limited. Complication reporting was inconsistent, follow-up was short (a median of 24 months), and some series were small.

Finally, the patient counts for the RFA review itself were inconsistent — the abstract reports 266 patients and the body text reports 225, which reflects the uneven quality of the underlying literature.

Practical Recommendations

Based on this review, patients with breast cancer that has spread to the liver may want to consider the following:

1. Ask whether you meet the favorable criteria. The best candidates have hormone receptor–positive primary tumors. They also have small (under 3 cm) or single liver metastases, no cancer outside the liver, and tumors that can be completely removed with clear margins.
2. Ask about the goal of treatment. In selected patients, surgery or ablation may reduce or delay the need for continuous systemic chemotherapy.
3. Discuss tissue testing. Liver surgery provides tumor tissue that can confirm the receptor status (estrogen receptor, progesterone receptor, HER2) of the metastatic disease, which may change your drug treatment plan.
4. Weigh the risks. Postoperative death occurred in 0% to 5% of patients across reports, and complications occurred in about 28% (range 18% to 42%). Major complications occurred in 3.5% to 12%. The typical hospital stay was 8.5 days.
5. Consider RFA if surgery is not suitable. RFA has a high technical success rate, lower complication rates, a median hospital stay of about 2 days, and can be repeated. It is generally used for smaller tumors.
6. Ask about repeat procedures. In one series, patients who had a second liver operation had dramatically better survival than those who had only one (median 100 vs. 35 months; 95% and 84% vs. 50% and 38% alive at 3 and 5 years).
7. Seek care at an experienced center. Nine of the 11 surgical studies were single-center analyses, and outcomes depend heavily on surgical expertise and patient selection.

Frequently Asked Questions

Who might be a good candidate for surgery to remove breast cancer that has spread to the liver?

Across the reviewed studies, the most favorable features were a hormone receptor–positive original breast cancer. Other favorable features were liver tumors that are small (under 3 cm) or single. Other favorable features were no cancer outside the liver and tumors that can be completely removed with clear margins. Patients with these features had better outcomes in multiple analyses, but no randomized trial has compared surgery with drug therapy alone.

What survival can I expect after liver surgery for breast cancer liver metastases?

In the pooled surgical series, median overall survival was 39.5 months, and 38% of patients — about 4 in 10 — were alive at 5 years. These numbers come from studies with different patient groups and selection criteria, and none of the patients received the newest drug therapies, so they must be interpreted carefully.

How does radiofrequency ablation (RFA) compare with surgery for these liver tumors?

RFA uses heat to destroy tumors without surgery. In the reviewed reports, median survival after RFA was 32 months and 5-year survival was 27%, compared with 39.5 months and 38% after surgery. RFA is less invasive, requires about 2 days in hospital, has lower complication rates, and can be repeated, but it is generally used for smaller tumors.

What are the risks and recovery time after liver surgery for breast cancer metastases?

Across the reports, postoperative death occurred in 0% to 5% of patients. Complications occurred in about 28% (range 18% to 42%), with major complications in 3.5% to 12%. The median hospital stay was 8.5 days (range 6 to 11 days). These figures come from selected patients in studies without randomization.

Can liver surgery help if my cancer has spread outside the liver?

In the reviewed studies, cancer outside the liver was linked to poorer overall survival in three multivariate analyses. Patients whose cancer was confined to the liver did better. However, some patients with extrahepatic metastases still had surgery, and the studies varied in how they selected patients, so individual situations differ.

What does a median survival of 39.5 months mean?

Median survival means that half of the patients in the pooled surgical series lived longer than 39.5 months and half lived less. It does not predict any one person's outcome. The range across studies was 26 to 82 months, and these results come from selected patients, not from a randomized trial.

Is a second liver operation ever considered?

In one series, patients who had a repeat hepatectomy (a second liver operation) lived longer than those who had only one. Median survival was 100 months versus 35 months. At 3 and 5 years, 95% and 84% versus 50% and 38% were alive. This was a small comparison, and repeat surgery is not suitable for everyone.

When should a patient with breast cancer that has spread to the liver seek a second opinion about liver surgery or ablation?

A second opinion is worth seeking when the liver is the only site of spread. A second opinion is also worth seeking when the tumors are small (under 3 cm) or solitary. A second opinion is also worth seeking when the original cancer was hormone receptor–positive. These features are linked to the longest survival after surgery. It also helps when it is unclear whether surgery, radiofrequency ablation, or drug therapy alone is appropriate, since no randomized trial has compared them. A review of records and imaging can clarify whether all visible tumor can be completely removed. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

Original article title: Surgical therapy for breast cancer liver metastases

Publication details: Translational Cancer Research, 2020; volume 9, number 8, pages 5053–5062. doi: 10.21037/tcr-20-1598. Submitted March 20, 2020; accepted May 15, 2020.

Note: This patient-friendly article is based on peer-reviewed research. It summarizes a review of published studies and does not replace personalized medical advice from your oncology team.