The significance of gastrectomy in advanced gastric cancer patients with hepatic metastasis

Abstract

This study was designed to investigate the role of palliative gastrectomy in advanced gastric adenocarcinoma patients having hepatic metastasis without extra-abdominal disease at diagnosis. Patients and methods: This study was performed in General Surgery Department, Tanta University Hospitals, Egypt on 29 patients with advanced gastric cancer having hepatic metastasis. Patients were selected with histopathologically proven gastric adenocarcinoma; presence of hepatic metastasis at the time of diagnosis; absence of extra-abdominal disease and having a performance status of 2 or less on the Eastern Cooperative Oncology Group (ECOG) scale. None had received prior chemotherapy or radiation therapy Patients were categorized into the two groups; Group I, 8 males and 3 females underwent gastrectomy with subsequent chemotherapy Eighteen patients in group II, 11 males and 7 females received chemotherapy alone without gastrectomy. All patients were treated with systemic 5-jluorouracil based regimens. Results: The mean follow-up time was 258±122 days. The mean survival of GI and Gil patients were 397±59.7 and 173±46.8 days (p > 0.0001). The mean metastatic progression­ free survival was 329±54.7 and 141±49.4 days (p > 0.001). In 11 {38%) of 29 patients the primary tumor was removed (total gastrectomy in 7 and distal gastrectomy 4 patients). No patient underwent liver resection. Wound infection developed in one of the patients of the resection group. He were conservatively treated One of the patients was reoperated for minor leakage from the anastomosis leading to intraabdominal collection. The mean hospital stay of the first admission for GI and Gil patients was 13.9 ±6.41 and 4.28±1.41 days respectively (p>O.0001). The Hospitalization index was not different between the two groups. The Ingestion index was significantly higher in GI than in Gil. Gastrectomy increased the survival of the patients regardless to their number and localization of hepatic metastasis. Related risk factors based on the univariate analysis were serum tumor marker levels (p 0.036), number of hepatic metastasis (p 0.0045), resection of primary tumor (p >0.0001) and the absence of extra hepatic spread (p 0.027). Conclusion: Despite stage IV patients have poor prognosis, removal of the intact primary tumor for gastric cancer with synchronous hepatic metastasis at diagnosis is associated with improvement in overall survival and metastatic progression-free survival.