Abstract
The optimal surgical strategy for the treatment of synchronous resectable gastric cancer liver metastases remains controversial. The aims of this study were to analyze the outcome and overall survival of patients presenting with gastric cancer and liver metastases treated by simultaneous resection. Between January 1990 and June 2009, 35 patients diagnosed with synchronous hepatic metastases from gastric carcinoma received simultaneous resection of both primary gastric cancer and synchronous hepatic metastases. The clinicopathologic features and the surgical results of the 35 patients were retrospectively analyzed. The 5-year overall survival rate after surgery was 14.3%. Five patients survived for more than 5 years after surgery. No mortality has occurred within 30 days after resection, although two patients (5.7%) developed complications during the peri-operative course. Univariate analysis revealed that patients with the presence of lymphovascular invasion of the primary tumor, bilateral liver metastasis and multiple liver metastases suffered poor survival. Lymphovascular invasion by the primary lesion and multiple liver metastases were significant prognostic factors that influenced survival in the multivariate analysis (p=0.02, p=0.001, respectively). The presence of lymphovascular invasion of the primary tumor and multiple liver metastases are significant prognostic determinants of survival. Gastric cancer patients without lymphovascular invasion and with a solitary synchronous liver metastasis may be good candidates for hepatic resection. Simultaneous resection of both primary gastric cancer and synchronous hepatic metastases may effectively prolong survival in strictly selected patients.
Highlights
Gastric carcinoma is the major cause of cancer related deaths in China (Zhang et al, 2014)
There is increasing evidence in the literature that hepatectomy for metastases from gastric cancer can improve survival with a 5-year survival rate of 10-38% (Okano et al, 2002; Sakamoto et al, 2003; Shirabe et al, 2003; Thelen et al, 2008; Tsujimoto et al, 2010), but few studies have addressed the value of surgical treatment in patients with gastric primary tumour and synchronous liver metastases
The surgical procedures used for the primary tumors included distal gastrectomy in 27 patients, total gastrectomy in 6 patients, and proximal gastrectomy in 2 patients. 24 patients had the maximum tumor diameter of liver metastases less than or equal to 2cm, and other 11 patients had the maximum tumor diameter greater than 2cm
Summary
Gastric carcinoma is the major cause of cancer related deaths in China (Zhang et al, 2014). There is increasing evidence in the literature that hepatectomy for metastases from gastric cancer can improve survival with a 5-year survival rate of 10-38% (Okano et al, 2002; Sakamoto et al, 2003; Shirabe et al, 2003; Thelen et al, 2008; Tsujimoto et al, 2010), but few studies have addressed the value of surgical treatment in patients with gastric primary tumour and synchronous liver metastases. Univariate analysis revealed that patients with the presence of lymphovascular invasion of the primary tumor, bilateral liver metastasis and multiple liver metastases suffered poor survival. Gastric cancer patients without lymphovascular invasion and with a solitary synchronous liver metastasis may be good candidates for hepatic resection. Simultaneous resection of both primary gastric cancer and synchronous hepatic metastases may effectively prolong survival in strictly selected patients
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