Long-term outcomes after surgical resection for gastric cancer liver metastasis: an analysis of 64 macroscopically complete resections

• Published in: Langenbeck's archives of surgery 2012-08, Vol.397 (6), p.951-957
• Main Authors: Takemura, Nobuyuki, Saiura, Akio, Koga, Rintaro, Arita, Junichi, Yoshioka, Ryuji, Ono, Yoshihiro, Hiki, Naoki, Sano, Takeshi, Yamamoto, Junji, Kokudo, Norihiro, Yamaguchi, Toshiharu
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Age Factors; Aged; Aged, 80 and over; Analysis of Variance; Cardiac Surgery; Cohort Studies; Disease-Free Survival; Female; Gastrectomy - methods; General Surgery; Hepatectomy - methods; Hepatectomy - mortality; Humans; Kaplan-Meier Estimate; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Original Article; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Sex Factors; Statistics, Nonparametric; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Survival Analysis; Thoracic Surgery; Time Factors; Traumatic Surgery; Treatment Outcome; Vascular Surgery
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-012-0959-z

Purpose The indication for hepatectomy in cases of gastric cancer liver metastases (GLM) remains unclear and it remains controversial whether surgical resection is beneficial for GLM. The objective of this retrospective study was to clarify the indications for and benefit of hepatectomy for GLM. Methods Seventy-three patients underwent hepatectomies for GLM from January 1993 to January 2011. Macroscopically complete (R0 or R1) resection was achieved in 64 patients. Among them, 32 patients underwent synchronous hepatectomy with gastrectomy and the remaining 32 patients underwent metachronous hepatectomy. Repeat hepatectomy was done in 14 patients for resectable intrahepatic recurrences. Clinicopathological factors were evaluated by univariate and multivariate analyses among patients who received macroscopically complete resection for those affecting survival. Results The overall 1-, 3-, and 5-year survival rates after macroscopically complete (R0 or R1) liver resection ( n  = 64) for GLM were 84, 50, and 37 %, respectively, with a median survival of 34 months. Univariate analysis identified serosal invasion of the primary gastric cancer and blood transfusions during surgery as poor prognosis indicators. By multivariate analysis, serosal invasion of the primary gastric cancer and larger hepatic tumor (>5 cm in diameter) were found to be independent indicators of poor prognosis. Conclusions GLM patients with the maximum diameter of hepatic tumors of