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

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.

Intestinal-type histology is associated with better prognosis in patients undergoing liver resection for gastric/esophagogastric-junction liver metastasis

“…The 5-year OS and RFS rates in our study are similar to those reported in previous studies. The OS and RFS rates reportedly ranged from 9.3% to 42.1% and from 8.6% to 27.7%, respectively (3)(4)(5)(6)(7)(12)(13)(14)(15)(16)(17)(18). The median OS time was 38.0 months for selected patients in our study, which was also comparable to previous studies, where it ranged from 11 to 36 months (3,6,15,16,18,19).…”

“…According to previous studies that included > 30 (108) patients in the past 5 years, multiple liver metastases, R1/R2 resection, synchronous metastases, maximum size of liver metastases, pT4 of primary tumor, and other distant metastases were reported to be risk factors for OS (3,5,6,16,18,19). Unlike the previously reported covariates, the diffuse-type adenocarcinoma in our study is one of the prognostic factors for OS and RFS, and it is a predictor of extra-liver metastasis development.…”

“…Although chemotherapy is regarded as the standard treatment for gastric/esophagogastric-junction liver metastases (GELMs), several retrospective studies have reported favorable prognosis for liver resection concerning GELM (3)(4)(5)(6)(7). These studies demonstrated the following risk factors for poor prognosis: number and maximum size of liver metastases; R1/R2 resection; synchronous metastases; primary tumor stage pT4; and the presence of other distal metastases.…”

ILF3 promotes gastric cancer proliferation and may be used as a prognostic marker

“…GC is one of the most common cancers in China, with high mortality due to its aggressiveness, and poor prognosis (11–13). Although a number of genes and signaling pathways involved in GC development have been identified (14–17), the mechanism is still too sophisticated to be fully understood.…”

Oligometastatic Disease in Upper Gastrointestinal Cancer - How to Proceed

“…The resection of distant metastases, however, did not significantly improve the survival compared to those patients in which only the primary tumor was removed [25]. In a small study on 35 Chinese patients undergoing both resection of the primary tumor and synchronous hepatic metastatic disease, Liu et al [26] identified lymphovascular invasion of the primary tumor and multiple liver metastases as negative prognostic factors for survival.…”