Surgical Indications, Timing, and Strategy in Non- colorectal Liver Metastases

Taking into consideration all primary solid tumors, the liver represents the most common site involved in distant metastasization, also due to its important blood reception from the majority of digestive organs. Despite the abundant literature and guidelines about colorectal liver metastases, there is still great debate about the treatment strategy in the case of non-colorectal ones. Therefore, in this chapter, we reviewed the treatment strategy and surgical indications for the most frequent non-colorectal liver metastases. In the case of neuroendocrine hepatic secondaries, the literature suggests that surgery should be always considered for patients with resectable hepatic disease, as this treatment results more likely to offer the best long-term outcome. For what concerns liver metastases from gastric cancer, surgical approach should always be undertaken if indications are appropriate, after a multidisciplinary discussion to plan an adequate multidisciplinary adjuvant treatment, a proper patient selection, and the exclusion of additional secondary tumors or extrahepatic metastases. Taking into consideration liver secondaries from breast cancer and their chemosensitivity, in the absence of brain and lung lesions, it can be considered a space for liver surgery, especially in the case of single lesions or a maximum of two lesions with dimensions within 3 cm. However, as the number of cancer survivors is progressively increasing and, with it, the number of patients affected by non-colorectal liver metastases, further randomized controlled trials are required in order to better define the benefit of hepatic surgery in these kinds of patients.