Gastric Cancer and Synchronous Hepatic Metastases: Is It Possible to Recognize Candidates to R0 Resection?

Purpose Management of patients with synchronous hepatic metastases as the sole metastatic site at diagnosis of gastric cancer is debated. We studied a cohort of patients admitted to surgical units, investigating prognostic factors of clinical relevance and the results of various therapeutic strategi...

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Bibliographic Details
Published in:Annals of surgical oncology 2015-02, Vol.22 (2), p.589-596
Main Authors: Tiberio, Guido Alberto Massimo, Baiocchi, Gian Luca, Morgagni, Paolo, Marrelli, Daniele, Marchet, Alberto, Cipollari, Chiara, Graziosi, Luigina, Ministrini, Silvia, Vittimberga, Giovanni, Donini, Annibale, Nitti, Donato, Roviello, Franco, Coniglio, Arianna, de Manzoni, Giovanni
Format: Article
Language:English
Subjects:
Aged
Chemotherapy, Adjuvant
Female
Gastrectomy
Gastrointestinal Oncology
Hepatectomy
Humans
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Liver Neoplasms - therapy
Male
Medicine
Medicine & Public Health
Neoplasms, Multiple Primary - secondary
Neoplasms, Multiple Primary - surgery
Neoplasms, Multiple Primary - therapy
Oncology
Palliative Care
Prognosis
Retrospective Studies
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Surgery
Surgical Oncology
Survival Analysis
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Summary:Purpose Management of patients with synchronous hepatic metastases as the sole metastatic site at diagnosis of gastric cancer is debated. We studied a cohort of patients admitted to surgical units, investigating prognostic factors of clinical relevance and the results of various therapeutic strategies. Methods Retrospective multicentre chart review. We evaluated how survival from surgery was influenced by patient-related, gastric cancer-related, metastasis-related and treatment-related candidate prognostic factors. Results Forty-four patients received palliative surgery without resection, 98 palliative gastrectomy (in 16 cases associated with R+ hepatectomy), whereas 53 patients received both curative gastrectomy and hepatic resection(s) (R0). Adjuvant chemotherapy was administered to 44 patients. Therapeutic approach was selected on the basis of extension of disease, patient’s general conditions and surgeon’s attitude. Surgical mortality was 4.6 % and morbidity was 17.4 %. Survival was independently influenced by the factor T of the gastric primary ( p  = 0.036) and by the degree of hepatic involvement ( p  = 0.010). T > 2 and H3 liver involvement were associated with worse prognosis with cumulative effect ( p  = 0.002). Therapeutic approach to the metastases ( p  = 0.009) and adjuvant chemotherapy ( p  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-014-4018-6