Multicentre analysis of long-term outcome after surgical resection for gastric cancer liver metastases

Kinoshita, Taira; Saiura, Akio; Esaki, Minoru; Sakamoto, Hirohiko; Yamanaka, Takahiro

doi:10.1002/bjs.9684

Cited by 118 publications

(142 citation statements)

References 23 publications

(26 reference statements)

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“…The number of positive PALNs has also been pointed out as a prognostic factor in previous studies (4,20). As in patients with limited metastatic gastric cancer, the number of liver metastases (one or two) has been identified as a prognostic factor after surgical resection when no extrahepatic metastasis is present (21). It is presumed that the number of lesions might be a pivotal factor associated with the prognosis in such patients with limited metastasis.…”

Section: Discussionmentioning

confidence: 90%

Prognostic Factors and Recurrence Pattern of Far-advanced Gastric Cancer with Pathologicallypositive Para-aortic Lymph Nodes

Kaito

Kinoshita

Tokunaga

et al. 2017

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Abstract. Background: The role of para-aortic lymph node (PALN) dissection for far-advanced gastric cancer is controversial in patients with tumor diameter of ≥120 mm (HR=3.37;. Patients with none of these factors survived significantly longer than those with any of these factors respectively; p<0.001). Conclusion: Pathologically PALN-positive patients achieve long survival; however, the indications for PALN dissection should be carefully considered.Para-aortic lymph node (PALN) metastasis from gastric cancer is classified as distant metastasis in both the 7th classification of the International Union against Cancer (1) and the 3rd English edition of the Japanese Gastric Cancer Classification (2). Thus, systemic chemotherapy is recommended as first-choice treatment in the current guidelines (3). In patients with advanced gastric cancer, the reported incidence of pathological metastasis to the PALNs is 8.5-30.0% (4-8). In one study, micrometastasis was detected by immunohistochemical staining in 64% of patients who underwent prophylactic PALN dissection (9). In several Japanese specialized centers, including ours, prophylactic PALN dissection was aggressively performed for advanced gastric cancer from the 1980s to the early 1990s. In 1995, a multi-institutional prospective randomized controlled trial comparing standard D2 dissection versus D2 plus PALN dissection for serosa-positive advanced gastric cancer without gross metastasis to the PALNs was conducted in Japan (JCOG9501) (10). This trial proved that the 5-year overall survival (OS) rates did not differ between the two groups (69.2% vs. 70.3%, respectively) and concluded that prophylactic PALN dissection is not effective (6). However, the incidence of pathologically positive PALNs in this trial was only 8.5%; thus, the benefit of PALN dissection for those patients could not be fully investigated.In general, the prognosis of patients with pathologicallypositive PALNs is thought to be unfavorable, even after systematic PALN dissection. However, it is known that a certain subpopulation of these patients can achieve long survival. The reported postoperative 5-year survival rate of patients with pathologically-positive PALNs is 16-25% (4, 6, 8, 11, 12). Due to progress in modern powerful perioperative chemotherapy regimens, it was recently suggested that the prognosis of these patients can be improved. A recent phase II trial (JCOG 0405) investigated the feasibility of neoadjuvant chemotherapy (2-3 cycles of S1+cisplatin) followed by radical gastrectomy with systematic PALN dissection for patients with clinically diagnosed metastasis to the PALNs (13). The R0 resection rate was 82% and the 5-year OS rate 57%. These 3685

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Section: Discussionmentioning

confidence: 90%

Prognostic Factors and Recurrence Pattern of Far-advanced Gastric Cancer with Pathologicallypositive Para-aortic Lymph Nodes

Kaito

Kinoshita

Tokunaga

et al. 2017

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“…Those results were maintained after propensity matching for the differences between groups. Other publications from the Far East [4][5][6][7], and some Western centers [14][15][16][17], have also suggested the safety of hepatectomy for gastric cancer liver metastases in selected patients. The results of this study also parallel the outcomes of hepatectomy for colorectal cancer liver metastases, where surgical resection is more common and is considered the standard of care for isolated hepatic metastases [11].…”

Section: Discussionmentioning

confidence: 99%

“…Gastrectomy in Eastern centers is associated with improved long-term survival compared to the West after controlling for disease stage and patient demographics [3]. Furthermore, in Eastern centers more attention has been given to the surgical treatment of liver metastases from gastric cancer [4][5][6][7] and toward gastrectomy as a reduction surgical strategy in the presence of a single noncurable factor that showed no survival improvement over chemotherapy alone [8].…”

Section: Introductionmentioning

confidence: 99%

Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England

et al. 2016

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Background The objectives of this national study were to examine the short-term safety and long-term survival benefit associated with surgical resection of hepatic metastases from gastric cancer. Methods Patients from the Hospital Episode Statistics database were classified by disease and treatment approach. Gastric cancer: 1. Without liver metastases treated by gastrectomy (GG). 2. With liver metastases treated by gastrectomy and hepatectomy (GGH). 3. With liver metastases treated by gastrectomy without hepatectomy (GGNH). 4. With liver metastases treated with no surgery (GNS). Propensity score matching and multivariable analyses were used to compensate for differences in some baseline characteristics. Results During the study period, 87,482 were patients diagnosed with gastric cancer, of whom 13,841 underwent partial or total gastrectomy. Of those who underwent gastrectomy, 336 had a diagnosis of liver metastases and 78 of these had a hepatectomy. Propensity-matched analysis showed no significant differences in 30-or 90-day mortality between the GGH and GG groups. The GGH group had significantly improved 1-year mortality (35.9 % vs. 50.0 %, p = 0.049) and 5-year mortality (61.5 % vs. 75.7 %, p = 0.031) compared to the GGNH group, and compared to the GNS group, the GCH group had 1-year mortality (35.9 % vs. 84.6 %, p \ 0.001) and 5-year mortality (61.5 % vs. 90.8 %, p \ 0.001). Conclusions This study showed that hepatectomy for synchronous gastric cancer hepatic metastases may carry survival benefits in selected patients. The data presented should not be a rationale to change current clinical practice but rather a stimulus to prospectively study the role of surgery in a selected group of patients who are currently treated with palliative chemotherapy.

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“…Even though almost all studies were small retrospective series, a limited number and small size of LM were favorable prognostic factors in patients who undergo hepatectomy. One multicenter retrospective analysis of 256 patients reported a promising median OS of 31.1 months [14]. A propensity-matched analysis using a national database in the United Kingdom showed that the prognosis of patients who underwent both gastrectomy and hepatectomy was better than of those who received no surgery [15].…”

Section: Introductionmentioning

confidence: 99%

Current management of liver metastases from gastric cancer: what is common practice? New challenge of EORTC and JCOG

et al. 2017

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The role of multidisciplinary treatment including surgery for liver metastases from gastric cancer (LMGC) is controversial. Studies to answer this clinical question are increasing in number, but all published data thus far are based on retrospective analyses with limited sample sizes. Thus, the European Organisation for Research and Treatment of Cancer (EORTC) Gastrointestinal Tract Cancer Group (GITCG) and the Japan Clinical Oncology Group (JCOG) Stomach Cancer Study Group (SCSG) initiated a collaboration to develop an optimal treatment strategy for LMGC. Before planning a prospective study, a questionnaire was sent out to the network members of both groups in June 2016 to clarify current common practice in each region. Sixty-seven sites from 17 countries in the EORTC network and 55 sites from Japan responded. According to the survey, for patients with resectable LMGC without extrahepatic metastases, preoperative chemotherapy followed by resection of both primary (if still in place) and liver lesions was the preferred option for both the synchronous and the metachronous setting. For patients with unresectable LMGC, most of the sites recommended chemotherapy only. In this article, the detailed results of this survey are reported, shedding light on current community practice, and a joint EORTC-JCOG strategy of investigation is delineated.

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Multicentre analysis of long-term outcome after surgical resection for gastric cancer liver metastases

Abstract: Clinically resectable GCLM is rare, but strict and careful patient selection can lead to long-term survival following R0 surgical resection.

Cited by 118 publications

References 23 publications

Prognostic Factors and Recurrence Pattern of Far-advanced Gastric Cancer with Pathologicallypositive Para-aortic Lymph Nodes

Prognostic Factors and Recurrence Pattern of Far-advanced Gastric Cancer with Pathologicallypositive Para-aortic Lymph Nodes

Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England

Current management of liver metastases from gastric cancer: what is common practice? New challenge of EORTC and JCOG

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