Gastric cancer with synchronous hepatic metastases: A multicentric Italian survey.

Abstract

Listen

Translate article

e15148 Background: The treatment of these patients is controversial and influenced by personal, often passive, attitude. Knowledge of variables affecting outcome may promote clinical pragmatism.We surveyed the clinical approach to the subset of patients presenting with synchronous hepatic metastases as sole metastatic site at diagnosis of gastric cancer, focusing on the results achieved by different treatments and investigated the prognostic factors of major clinical relevance. Methods: Retrospective multi-centre chart review evaluating 210 patients admitted in surgical units. We studied how survival from surgery or diagnosis was influenced by different patient-related, gastric cancer-related, metastases-related and treatment-related candidate prognostic factors. Results: Seventeen patients received supportive care, 44 minor palliative surgery, 98 palliative gastrectomy in 16 cases associated to R+ hepatectomy, while 51 patients received both curative gastrectomy and hepatic resection/s (R0). Adjuvant chemotherapy was administered to 41 patients. Therapeutic approach was selected on the basis of stage of disease, patients’ general conditions and surgeon’s attitude toward the disease, without any pre-set common criteria, in absence of institutional protocols or guidelines. Surgical mortality was 4.6%, surgical morbidity 17.6%. Survival was independently influenced by the degree of hepatic involvement (p= 0.036) but therapeutic approach to the metastases was the principal prognostic variable (p<0.001): 1, 3, and 5 years survival rates were 48.3%, 11.8% and 7.1%, respectively, for patients submitted to curative surgery (R0), 16%, 4.3% and 2.1% after palliative (R+) gastrectomy, 6,8%, 0% and 0% after minor palliative surgery and 0%,0% and 0% with supportive care. Chemotherapy displayed a clear prognostic role (p< 0.001) with clear benefit for those receiving adjuvant treatment. Conclusions: Our data show that an aggressive multimodal approach offers the best survival chances, the best results being offered by the association of radical (R0) surgery and adjuvant chemotherapy. Upon these bases we conclude that this aggressive management must be pursued whenever possible.