Share This Article:

Surgical Treatment of Liver Metastases from Gastric Cancer

Abstract Full-Text HTML Download Download as PDF (Size:210KB) PP. 393-400
DOI: 10.4236/ss.2013.49077    2,474 Downloads   3,628 Views   Citations

ABSTRACT

Background: Hepatectomy for gastric metastases remains controversial. We aimed at assessing the surgical results, clinicopathological features of gastric cancer liver metastases (GCLM) and prognostic factors. Methods: The outcome of 28 consecutive patients with synchronous (n = 24) or metachronous (n = 4) GCLM was retrospectively analyzed. Curatively, initial hepatectomies such as segmentectomy and hemihepatectomy or non-anatomical limited liver resection less extensive than segmentectomy followed complete primary gastric cancer (GC) resections. Results: Median survival time was 16 months (range, 5 - 66 months). The actuarial overall 12-, 36-, and 60-month survival rates after hepatectomy were 67.8% (n = 19), 39.2% (n = 11), and 28.5% (n = 8), respectively. In multivariate analysis, absent GC serosal invasion-hazard ratio (HR) 1; 95% confidence interval (CI) 1.2 - 9.9; P = 0.020; solitary LM-HR 1; 95% CI 1.6 - 16.0; P = 0.005, and curative liver resection with negative resection margin (R0)-HR 1, 95% CI 2.2 - 18.0; P = 0.001 were independent prognostic factors. Conclusions: Surgery of GCLM is a good indication in well-selected patients with an absent serosal invasion of primary tumour, single GCLM and attainment of R0 liver resection. For most GCLM patients, however, there are no other therapeutic modalities. Thus systemic chemotherapy remains the best hope for a longer patient’s survival and an improved individual quality of life.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

D. Kostov, G. Kobakov and D. Yankov, "Surgical Treatment of Liver Metastases from Gastric Cancer," Surgical Science, Vol. 4 No. 9, 2013, pp. 393-400. doi: 10.4236/ss.2013.49077.

References

[1] A. Jemal, R. Siegel, E. Ward, Y. Hao, J. Xu and M. J. Thun, “Cancer Statistics 2009,” CA: A Cancer Journal for Clinicians, Vol. 59, No. 4, 2009, pp. 225-249. doi:10.3322/caac.20006
[2] J. L. Dikken, C. J. van de Velde, D. G. Coit, M. A. Shah, M. Verheij and A. Cats, “Treatment of Resectable Gastric Cancer,” Therapeutic Advances in Gastroenterology, Vol. 5, No. 1, 2012, pp. 49-69.
[3] A. Shin, J. Kim and S. Park, “Gastric Cancer Epidemiology in Korea,” Journal of Gastric Cancer, Vol. 11, No. 3, 2011, pp. 135-140. doi:10.5230/jgc.2011.11.3.135
[4] B. Schlansky and A. Sonnenberg, “Epidemiology of Noncardia Gastric Adenocarcinoma in the United States,” American Journal of Gastroenterology, Vol. 106, No. 11, 2011, pp. 1978-1985. doi:10.1038/ ajg.2011.213
[5] E. Linhares, M. Monteiro, R. Kesley, C. E. Santos, O. S. Filho and J. H. Simoes, “Major Hepatectomy for Isolated Metastases from Gastric Adenocarcinoma,” HPB (Oxford), Vol. 5, No. 4, 2003, pp. 235-237.
[6] K Shirabe, S Wakiyama, T Gion, M Watanabe, M Miyazaki, K Yoshinaga, M. Tokunaga and T. Nagaie, “Hepatic Resection for the Treatment of Liver Metastases in Gastric Carcinoma: Review of the Literature,” HPB (Oxford), Vol. 8, No. 2, 2006, pp. 89-92. doi:10.1080/13651820500472168
[7] Thelen, S. Jonas, C. Benckert, E. Lopez-H?nninen, U. Neumann, B. Rudolph, G. Schumacher and P. Neuhaus, “Liver Resection for Metastatic Gastric Cancer,” European Journal of Surgical Oncology, Vol. 34, No. 12, 2008, pp. 1328-1334.
[8] Y. Sakamoto, S. Ohyama, J. Yamamoto, K. Yamada, M. Seki, K. Ohta, N. Kokudo, T. Yamaguchi, T. Muto and M. Makuuchi, “Surgical Resection of Liver Metastases of Gastric Cancer: An Analysis of a 17-Year Experience with 22 Patients,” Surgery, Vol. 133, No. 5, 2003, pp. 507-511. doi:10.1067/ msy.2003.147
[9] H. Jerraya, A. Saidani, M. Khalfallah, I. Bouasker, R. Nouira and C. Dziri, “Management of Liver Metastases from Gastric Carcinoma: Where Is the Evidence?” La Tunisie Médicale, Vol. 91, No. 1, 2013, pp. 1-5.
[10] J. A. Ajani, “Evolving Chemotherapy for Advanced Gastric Cancer,” Oncologist, Vol. 10, Suppl. 3, 2005, pp. S49-S58. doi:10.1634/theoncologist.10-90003-49
[11] Y. N. Wang, K. T. Shen, J. Q. Ling, X. D. Gao, Y. Y. Hou, X. F. Wang, J. Qin, Y. H. Sun and X. Y. Qin, “Prognostic Analysis of Combined Curative Resection of the Stomach and Liver Lesions in 30 Gastric Cancer Patients with Synchronous Liver Metastases,” BMC Surgery, Vol. 12, No. 1, 2012, p. 20.
[12] S. P. Kerkar, C. D. Kemp and I. Avital, “Liver Resections in Metastatic Gastric Cancer,” HPB (Oxford), Vol. 12, No. 9, 2010, pp. 589-596. doi:10.1111/j.1477-2574.2010.00224.x
[13] K. Kumagai, K. Shimizu, N. Yokoyama, S. Aida, T. Tanaka and K. Yamagata, “Gastrointestinal Cancer Metastasis and Lymphatic Advancement,” Surgery Today, Vol. 40, 2010, pp. 301-306. doi:10.1007/ s00595-009-4142-2
[14] K. Okano, T. Maeba, K. Ishimura, Y. Karasawa, F. Goda, H. Wakabayashi, H. Usuki and H. Maeta, “Hepatic Resection for Metastatic Tumors from Gastric Cancer,” Annals of Surgery, Vol. 235, No. 1, 2002, pp. 86-91. doi:10.1097/00000658-200201000-00011
[15] R. Koga, J. Yamamoto, S. Ohyama, A. Saiura, M. Seki, Y. Seto and T. Yamaguchi, “Liver Resection for Metastatic Gastric Cancer: Experience with 42 Patients Including Eight Long-Term Survivors,” Japanese Journal of Clinical Oncology, Vol. 37, No. 11, 2007, pp. 836-842. doi:10.1093/jjco/hym113
[16] Y. Sakamoto, T. Sano, K. Shimada, M. Esaki, M. Saka, T. Fukagawa, H. Usuki and H. Maeta, “Favorable Indications for Hepatectomy in Patients with Liver Metastases from Gastric Cancer,” Journal of Surgical Oncology, Vol. 95, No. 7, 2007, pp. 534-539. doi:10.1002/jso.20739
[17] F. Romano, M. Garancini, F. Uggeri, L. Degrate, L. Nespoli, L. Gianotti, A. Nespoli and F. Uggeri, “Surgical Treatment of Liver Metastases of Gastric Cancer: State of the Art,” World Journal of Surgical Oncology, Vol. 10, 2012, p. 157. doi:10.1186/1477-7819-10-157
[18] T. Ochiai, M. Sasako, S. Mizuno, T. Kinoshita, T. Takayama, T. Kosuge, S. Yamazaki and K. Maruyama, “Hepatic Resection for Metastatic Tumours from Gastric Cancer: Analysis of Prognostic Factors,” British Journal of Surgery, Vol. 81, No. 8, 1994, pp. 1175-1178. doi:10.1002/bjs.1800810832
[19] Y. Kodera, H. Nakanishi, S. Ito, Y. Yamamura, Y. Kanemitsu, Y. Shimizu, T. Hirai, K. Yasui, T. Kato and M. Tatematsu, “Quantitative Detection of Disseminated Cancer Cells in the Greater Omentum of Gastric Carcinoma Patients with Real-time RT-PCR: A Comparison with Peritoneal Lavage Cytology,” Gastric Cancer, Vol. 5, No. 2, 2002, pp. 69-76. doi:10.1007/s101200200012
[20] Z. Morise, A. Sugioka, S. Hoshimoto, T. Kato, M. Ikeda, I. Uyama, A. Horiguchi and S. Miyakawa, “The Role of Hepatectomy for Patients with Liver Metastases of Gastric Cancer,” Hepatogastroenterology, Vol. 55, No. 85, 2008, pp. 1238-1241.
[21] D. Elias, A. Cavalcanti de Albuquerque, P. Eggenspieler, B. Plaud, M. Ducreux, M. Spielmann, C. Theodore, S. Bonvalot and P. Lasser, “Resection of Liver Metastases from a Noncolorectal Primary: Indications and Results Based on 147 Monocentric Patients,” Journal of the American College of Surgeons, Vol. 187, No. 5, 1998, pp. 487-493. doi:10.1016/S1072-7515(98)00225-7
[22] M. Miyazaki, H. Itoh, K. Nakagawa, S. Ambiru, H. Shimizu, A. Togawa, M. Shiobara, M. Ohtsuka, K. Sasada, Y. Shimizu, S. Yoshioka, N. Nakajima, T. Suwa and F. Kimura, “Hepatic Resection of Liver Metastases from Gastric Carcinoma,” American Journal of Gastro-Enterology, Vol. 92, No. 3, 1997, pp. 490-493.
[23] H. Tsujimoto, T. Ichikura, S. Ono, H. Sugasawa, S. Hiraki, N. Sakamoto, Y. Yaguchi, K. Hatsuse, J. Yamamoto and K. Hase, “Outcomes for Patients Following Hepatic Resection of Metastatic Tumors from Gastric Cancer,” Hepatology International, Vol. 4, No. 1, 2010, pp. 406-413. doi:10.1007/ s12072-009-9161-y
[24] S. H. Cheon, S. Y. Rha, H. C. Jeung, C. K. Im, S. H. Kim, H. R. Kim, J. B. Ahn, J. K. Roh, S. H. Noh and H. C. Chung, “Survival Benefit of Combined Curative Resection of the Stomach (D2 Resection) and Liver in Gastric Cancer Patients with Liver Metastases,” Annals of Oncology, Vol. 19, No. 6, 2008, pp. 1146-1153. doi:10.1093/annonc/mdn026
[25] A. Saiura, N. Umekita, S. Inoue, T. Maeshiro, S. Miyamoto, Y. Matsui, M. Asakage and M. Kitamura, “Clinicopathological Features and Outcome of Hepatic Resection for Liver Metastases from Gastric Cancer,” Hepatogastroenterology, Vol. 49, No. 46, 2002, pp. 1062-1065.
[26] S. Ambiru, M. Miyazaki, H. Ito, K. Nakagawa, H. Shimizu, H. Yoshidome, Y. Shimizu and N. Nakajima, “Benefits and Limits of Hepatic Resection for Gastric Metastases,” American Journal of Surgery, Vol. 181, No. 3, 2001, pp. 279-283. doi:10.1016/S0002-9610(01)00567-0
[27] H. R. Roh, K. S. Suh, H. J. Lee, H. K. Yang, K. J. Choe and K. U. Lee, “Outcome of Hepatic Resection for Metastatic Gastric Cancer,” The American Surgeon, Vol. 71, No. 2, 2005, pp. 95-99.
[28] K. Ueda, M. Iwahashi, M. Nakamori, M. Nakamura, T. Naka, K. Ishida, T. Ojima and H. Yamaue, “Analysis of the Prognostic Factors and Evaluation of Surgical Treatment for Synchronous Liver Metastases from Gastric Cancer,” Langenbeck’s Archives of Surgery, Vol. 394, No. 4, 2009, pp. 647-653. doi:10.1007/s00423-008-0311-9
[29] J. Zacherl, M. Zacherl, C. Scheuba, R. Steininger, E. Wenzl, F. Mühlbacher, R. Jakesz and F. L?ngle, “Analysis of Hepatic Resection of Metastases Originating from Gastric Adenocarcinoma,” Journal of Gastrointestinal Surgery, Vol. 6, No. 5, 2002, pp. 682-689. doi:10.1016/S1091-255X(01)00075-0
[30] T. Nomura, Y. Kamio, N. Takasu, T. Moriya, A. Takeshita, M. Mizutani, O. Hachiya, I. Hirai and W. Kimura, “Intrahepatic Micrometastases Around Liver Metastases from Gastric Cancer,” Journal of Hepato-Biliary-Pancreatic Surgery, Vol. 16, No. 4, 2009, pp. 493-501. doi:10.1007/s00534-009-0081-y
[31] K. Fujii, S. Fujioka, K. Kato, Y. Machici, Y. Kutsuna, A. Ishikawa, J. Takamizawa, K. Ko, K. Yoshida and Y. Nimura, “Resection of Liver Metastases from Gastric Adenocarcinoma,” Hepatogastroenterology, Vol. 48, No. 38, 2001, pp. 368-371.
[32] M. Garancini, F. Uggeri, L. Degrate, L. Nespoli, L. Gianotti, A. Nespoli, F. Uggeri and F. Romano, “Surgical Treatment of Liver Metastases of Gastric Cancer: Is Local Treatment in a Systemic Disease Worthwhile?” HPB (Oxford), Vol. 14, No. 3, 2012, pp. 209-215.
[33] Y. Maehara, S. Hasuda, T. Koga, E. Tokunaga, Y. Kakeji and K. Sugimachi, “Postoperative Outcome and Sites of Recurrence in Patients Following Curative Resection of Gastric Cancer,” British Journal of Surgery, Vol. 87, No. 3, 2000, pp. 353-357. doi:10.1046/j.1365-2168.2000.01358.x
[34] C. H. Yoo, S. H. Noh, D. W. Shin, S. H. Choi and J. S. Min, “Recurrence Following Curative Resection for Gastric Carcinoma,” British Journal of Surgery, Vol. 87, No. 2, 2000, pp. 236-242. doi:10.1046/j.1365-2168.2000.01360.x
[35] S. H. Cheon, S. Y. Rha, H. C. Jeung, C. K. Im, S. H. Kim, H. R. Kim, J. B. Ahn, J. K. Roh, S. H. Noh and H. C. Chung, “Survival Benefit of Combined Curative Resection of the Stomach and Liver in Gastric Cancer Patients with Liver Metastases,” Annals of Oncology, Vol. 19, No. 6, 2008, pp. 1153-1158.
[36] H. Makino, C. Kunisaki, Y. Izumisawa, M. Tokuhisa, T. Oshima, Y. Nagano, S. Fujii, J. Kimura, R. Takagawa, T. Kosaka, H. A. Ono, H. Akiyama, K. Tanaka and I. Endo, “Indication for Hepatic Resection in the Treatment of Liver Metastasis from Gastric Cancer,” Anticancer Research, Vol. 30, No. 6, 2010, pp. 2367-2376.
[37] R. Adam, L. Chiche, T. Aloia, D. Elias, R. Salmon, M. Rivoire, D. Jaeck, J. Saric, Y. P. Le Treut, J. Belghiti, G. Mantion and G. Mentha; Association Fran?aise de Chirurgie, “Hepatic Resection for Noncolorectal Nonendocrine Liver Metastases. Analysis of 1452 Patients and Development of a Prognostic Model,” Annals of Surgery, Vol. 244, No. 4, 2006, pp. 524-535. doi:10.1097/01.sla.0000239036.46827.5f
[38] T. Miyazawa, K. Ebe, N. Koide and N. Fujita, “Complete Response of Liver Metastasis of Gastric Cancer Treated by s-1 Chemoradiotherapy: a Case Report,” Case Reports in Oncological Medicine, 2012; 2012:368428. doi: doi:10.1155/2012/368428
[39] D. L. Page, I. D. Flemming, A. Fritz, C. M. Balch, D. G. Haller and M. Morrow, “American Joint Committee on Cancer, “Cancer Staging Manual,” 6th Edition, Springer, New York, 2002.
[40] T. J. Vogl, T. Gruber-Rouh, K. Eichler, N. E. Nour-Eldin, J. Trojan, S. Zangos and N. N. Naguib, “Repetitive Transarterial Chemoembolization (TACE) of Liver Metastases from Gastric Cancer: Local Control and Survival Results,” European Journal of Radiology, Vol. 82, No. 2, 2013, pp. 163-258.

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.