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Abstract
Introduction/Background The infiltration of liver parenchyma is present in up to 20% of advanced ovarian cancer. Two distinct patterns of parenchymal involvement have been described: LPI (liver peritoneal infiltration) due to the ab-extrinsic invasion of liver parenchyma from a peritoneal seeding and HHM (Hematogenous hepatic metastases) due to the hematogenous drainage of neoplastic cells through the portal venous system. The aim of this study was to describe the anatomical localization of liver parenchymal infiltration according to the infiltrative pattern (LPI vs HHM).
Methodology In this restrospective observational study we retrieved 94 patients diagnosed with advanced ovarian cancer and liver involvement, treated at Fondazione Policlinico Universitario Agostino Gemelli, from January 2015 to May 2022. All patients experienced a liver resection due to parenchymal infiltration as a part of their first cytoreductive surgery.
Results Seventy-five patients were classified in the LPI-group and 19 in the HHM-group.
The median number of infiltrated segments was significantly higher in the HHM-group (1.3 vs. 1.6, p=0.036). LPI was more frequently reported in segments VI (40%) and VII (37.3%), respectively corresponding to the hepato-renal and right sub-phrenic recess, while HHM were more equally distributed to both left and right liver segments (figure1).
The median size of liver metastases was 10mm in LPI and 20mm in the HHM(p=0.02)
Atypical resections were significantly more frequent in LPI (92%), while segmentectomy in the HHM group (78.9%, p<0.001).
Conclusion LPI was significantly associated with localizations on liver segments that are in contact with peritoneal recess or peritoneal fold where neoplastic cells can easily settle and implant, along the clockwise circulation of the peritoneal fluid.
HHM demonstrated a more heterogeneous and diffuse anatomical distribution, were significantly larger and required a higher rate of liver ‘anatomical’ resections.
Disclosures None