Predictors of improved overall survival after resection of gastric cancer liver metastases

Abstract

Introduction: Hepatectomy (Hp) in the treatment of gastric cancer liver metastases (GCLM), although controversial, can be useful in selected patients. Patient selection is of paramount importance. We intend to evaluate clinical and pathological factors associated with improved outcome. Methods: Clinico-pathological review of 20 consecutive patients (13 men; mean age 66,4 years) that underwent surgical resection of GCLM in our department (February of 1997 to December of 2017). Metastases were synchronous with the primary tumour in 16 cases. Single nodule in 12 patients; mean size was 34.2±23.2mm. Hp was minor in 17 cases and synchronous with gastrectomy in seven cases. 90-day postoperative morbidity graded according to Dindo-Clavien. Statistical analysis with SPSS™ v. 24.0 (log rank, Kaplan-Meier and Cox regression). Results: Major morbidity in four (21%) and mortality in one patient (5%) (esophago-jejunal anastomosis dehiscence). Median overall survival (OS) was 18 months and 5-year survival was 21.2%. Two patients survived for over 10 years. Factors associated with a improved overall survival were: absence of major morbidity, interval between surgeries longer than 8 months, intestinal type, location in antrum or body of the of gastric tumor and metastases smaller than 20mm (p< 0.05). Independent predictors of better survival were: absence of major morbidity, metachronous resection, time between surgeries, type, location and T of gastric tumor and size of the metastases (p< 0.05). Conclusion: Distal and early gastric cancer, as well as metachronous resection, were independent predictors of longer overall survival. Selected patients with GCLM will benefit from Hp.