**Author details**

8 Recent Advances in Liver Diseases and Surgery

surgical indications for breast cancer liver metastasis.

blood reception from the majority of digestive organs.

43 months after the last procedure.

**5. Conclusive Summary**

resectable hepatic disease.

follow-up survival rates are of 34–80%. Interestingly, the rates of postoperative mortality are of 0% and morbidity of 0–44% that make absolutely acceptable the surgical treatment in these cases thus selected. Prognostic factors evaluated in multivariate methods ultimately lead to the conclusion that the only real risk factor is represented by the positive resection margin. Considering these results and taking into account the chemosensitivity of breast cancer emerges the consideration that even in cases of more consistent hepatic invasion, in the absence of brain and lung lesions, it can be considered a space for liver surgery [126]. It is evident from many series that survival is influenced by the state of the free margin, although not always the gap between R0 and R1 leads to a robust statistical difference [122]. Therefore, considering the possibility of a chemotherapy response and the greater possibility of surgical treatment also linked to the impact of new intraoperative technologies (e.g., radio frequency and microwave), it seems natural to expect in the immediate future an expansion of the

As a paradigm of these considerations, we take as example the case of a woman who after two breast surgeries for two metachronous cancers underwent chemotherapy for the appearance of liver metastases, with partial response, followed by rupture of one of the lesions and therefore emergency surgery for hemoperitoneum. Subsequently, after about six months, she developed a second hemoperitoneum treated again by surgical hemostasis. Afterward, she was transferred to our center and it was then made with palliative intent a major liver resection, left hepatectomy en bloc with part of the stomach and removal of two peritoneal implants. In the same intervention, the other two lesions on the right liver lobe were not treated. These two lesions were later treated by radiofrequency ablation combined with transcatheter arterial chemoembolization. Surprisingly the patient is alive and disease-free

Thanks to the improvement in the diagnostic and therapeutic pathways, the number of cancer survivors is progressively increasing, as well as the number of metastatic patients. Taking into consideration all primary solid tumors, the liver represents the most frequent site involved by distant metastasization, also due to its anatomical position and its important

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. Anyway, many experiences have been published in the last decades about surgical treatment of the most frequent non-colorectal liver metastases. In particular, we reviewed surgical strategies in the case of hepatic secondaries from neuroendocrine tumors, gastric cancer, and breast cancer. And in every case, the literature suggests a role for hepatic surgery for patients with

However, the number of considered patients is often very limited as well as the statistical strength of the current literature. Therefore, further randomized controlled trials are required

in order to better define the benefit of hepatic surgery in these kinds of patients.

Alessandro Uzzau1∗, Serena Bertozzi1,2, Ambrogio P Londero3, Stefano Bacchetti1, Enrico Maria Pasqual1, Andrea Risaliti1

\*Address all correspondence to: alessandro.uzzau@uniud.it

1 Clinic of Surgery, DISM, DSMB, University of Udine, Italy

2 IRCCS CRO, Aviano (PN), Italy

3 Unit of Obstetrics and Gynecology, S. Polo Hospital, Monfalcone (GO), Italy
