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Outcome after Simultaneous Resection of Gastric Primary Tumour and Synchronous Liver Metastases: Survival Analysis of a Single-center Experience in China

  • Liu, Qian (Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College) ;
  • Bi, Jian-Jun (Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College) ;
  • Tian, Yan-Tao (Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College) ;
  • Feng, Qiang (Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College) ;
  • Zheng, Zhao-Xu (Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College) ;
  • Wang, Zheng (Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College)
  • Published : 2015.03.09

Abstract

Background: 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. Materials and Methods: 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. Results: 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). Conclusions: 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.

Keywords

References

  1. Ambiru S, Miyazaki M, Ito H, et al (2001). Benefits and limits of hepatic resection for gastric metastases. Am J Surg, 181, 279-83. https://doi.org/10.1016/S0002-9610(01)00567-0
  2. Bines SD, England G, Deziel DJ, et al (1993). Synchronous, metachronous, and multiple hepatic resections of liver tumors originating from primary gastric tumors. Surgery, 114, 799-805; discussion 4-5.
  3. Cheon SH, Rha SY, Jeung HC, et al (2008). Survival benefit of combined curative resection of the stomach (D2 resection) and liver in gastric cancer patients with liver metastases. Ann Oncol, 19, 1146-53. https://doi.org/10.1093/annonc/mdn026
  4. Garancini M, Uggeri F, Degrate L, et al (2012). Surgical treatment of liver metastases of gastric cancer: is local treatment in a systemic disease worthwhile? HPB (Oxford), 14, 209-15. https://doi.org/10.1111/j.1477-2574.2011.00428.x
  5. Kerkar SP, Kemp CD, Avital I (2010). Liver resections in metastatic gastric cancer. HPB (Oxford), 12, 589-96. https://doi.org/10.1111/j.1477-2574.2010.00224.x
  6. Koga R, Yamamoto J, Ohyama S, et al (2007a). Liver resection for metastatic gastric cancer: experience with 42 patients including eight long-term survivors. Jpn J Clin Oncol, 37, 836-42. https://doi.org/10.1093/jjco/hym113
  7. Koga R, Yamamoto J, Ohyama S, et al (2007b). Liver resection for metastatic gastric cancer: experience with 42 patients including eight long-term survivors. Jpn J Clin Oncol, 37, 836-42. https://doi.org/10.1093/jjco/hym113
  8. Kumagai K, Tanaka T, Yamagata K, et al (2001). Liver metastasis in gastric cancer with particular reference to lymphatic advancement. Gastric Cancer, 4, 150-5. https://doi.org/10.1007/PL00011738
  9. Maehara Y, Moriguchi S, Kakeji Y, et al 1991. Pertinent risk factors and gastric carcinoma with synchronous peritoneal dissemination or liver metastasis.
  10. Mann CD, Neal CP, Pattenden CJ, et al (2008). Major resection of hepatic colorectal liver metastases in elderly patients -an aggressive approach is justified. Eur J Surg Oncol, 34, 428-32. https://doi.org/10.1016/j.ejso.2007.03.013
  11. Morise Z, Sugioka A, Hoshimoto S, et al (2008). The role of hepatectomy for patients with liver metastases of gastric cancer. Hepatogastroenterology, 55, 1238-41.
  12. Ochiai T, Sasako M, Mizuno S, et al (1994). Hepatic resection for metastatic tumours from gastric cancer: analysis of prognostic factors. Br J Surg, 81, 1175-8. https://doi.org/10.1002/bjs.1800810832
  13. Okano K, Maeba T, Ishimura K, et al (2002). Hepatic resection for metastatic tumors from gastric cancer. Ann Surg, 235, 86-91. https://doi.org/10.1097/00000658-200201000-00011
  14. Okano K, Yamamoto J, Moriya Y, et al (1999). Macroscopic intrabiliary growth of liver metastases from colorectal cancer. Surgery, 126, 829-34. https://doi.org/10.1016/S0039-6060(99)70022-X
  15. Qiu JL, Deng MG, Li W, et al (2013). Hepatic resection for synchronous hepatic metastasis from gastric cancer. Eur J Surg Oncol, 39, 694-700. https://doi.org/10.1016/j.ejso.2013.03.006
  16. Sakamoto Y, Ohyama S, Yamamoto J, et al (2003). Surgical resection of liver metastases of gastric cancer: an analysis of a 17-year experience with 22 patients. Surgery, 133, 507-11. https://doi.org/10.1067/msy.2003.147
  17. Sakamoto Y, Sano T, Shimada K, et al (2007). Favorable indications for hepatectomy in patients with liver metastasis from gastric cancer. J Surg Oncol, 95, 534-9. https://doi.org/10.1002/jso.20739
  18. Shirabe K, Shimada M, Matsumata T, et al (2003). Analysis of the prognostic factors for liver metastasis of gastric cancer after hepatic resection: a multi-institutional study of the indications for resection. Hepatogastroenterology, 50, 1560-3.
  19. Thelen A, Jonas S, Benckert C, et al (2008). Liver resection for metastatic gastric cancer. Eur J Surg Oncol, 34, 1328-34. https://doi.org/10.1016/j.ejso.2008.01.022
  20. Tiberio GA, Coniglio A, Marchet A, et al (2009). Metachronous hepatic metastases from gastric carcinoma: a multicentric survey. Eur J Surg Oncol, 35, 486-91. https://doi.org/10.1016/j.ejso.2008.12.017
  21. Tsujimoto H, Ichikura T, Ono S, et al (2010). Outcomes for patients following hepatic resection of metastatic tumors from gastric cancer. Hepatol Int, 4, 406-13. https://doi.org/10.1007/s12072-009-9161-y
  22. Wang JC, Tian JH, Ge L, et al (2014a). Which is the best Chinese herb injection based on the FOLFOX regimen for gastric cancer? A network meta- analysis of randomized controlled trials. Asian Pac J Cancer Prev, 15, 4795-800. https://doi.org/10.7314/APJCP.2014.15.12.4795
  23. Wang Z, Ma L, Zhang XM, et al (2014b). Long-term outcomes after D2 gastrectomy for early gastric cancer: survival analysis of a single-center experience in China. Asian Pac J Cancer Prev, 15, 7219-22. https://doi.org/10.7314/APJCP.2014.15.17.7219
  24. Yasui K, Hirai T, Kato T, et al (1997). A new macroscopic classification predicts prognosis for patient with liver metastases from colorectal cancer. Ann Surg, 226, 582-6. https://doi.org/10.1097/00000658-199711000-00002
  25. Zhang XM, Wang Z, Liang JW, et al (2014). Analysis of laparoscopy-assisted gastric cancer operations performed by inexperienced junior surgeons. Asian Pac J Cancer Prev, 15, 5077-81. https://doi.org/10.7314/APJCP.2014.15.12.5077