TITLE:
Surgical Treatment of Liver Metastases from Gastric Cancer
AUTHORS:
Daniel Vasilev Kostov, Georgi Leonidov Kobakov, Daniel Veselov Yankov
KEYWORDS:
Gastric Cancer; Liver Metastases; Hepatectomy; Survival; Prognostic Factors; Univariate Analysis; Multivariate Analysis
JOURNAL NAME:
Surgical Science,
Vol.4 No.9,
September
10,
2013
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, andcurative 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.