Surgical treatment of hepatic metastases from gastric cancer

Abstract

The purpose of the study was to investigate the clinical factors influencing the prognosis of patients submitted to hepatectomy for metastases from gastric cancer and their clinical role. We conducted a retrospective multicentre review. We evaluated how survival from surgery was influenced by patient-related, tumour-related and treatment-related prognostic factors. We analysed data on 144 patients submitted to hepatectomy for metastases from gastric cancer, in the synchronous and metachronous setting. In 117 cases, an R0 resection was achieved, while in 27 an R + hepatic resection was performed. Chemotherapy was administered to 55 patients. Surgical mortality was 2.1% and morbidity 21.5%. One-, 3-, and 5-year OS rates after surgery were 49.9, 19.4 and 11.6%, respectively, with a median OS of 12.0 months. T4 gastric cancer, H3 hepatic involvement, non-curative resection, recurrence after surgery, and abstention from chemotherapy were associated with a worse prognosis. Factor T and H displayed a clear (p < 0.001) cumulative effect. Our data show that R0 resection must be pursued whenever possible. The treatment of T4 gastric cancer with hepatic bilateral and diffuse metastasis (H3) should be considered carefully or it should be probably avoided. Finally, a multimodal treatment associating surgery and chemotherapy offers the best survival results.

Is there a role for treatment-oriented surgery in liver metastases from gastric cancer?

“…In 1994, one of the first studies on the subject[ 22 ] showed how the presence of serous invasion of gastric cancer was a determining prognostic factor in the resection of synchronous hepatic metastases. Since then, T stage has been extensively investigated[ 8 , 14 , 23 - 31 ]. Serous invasion is the first step in metastatic spread to the peritoneal cavity, an unfavorable prognostic factor[ 22 ].…”

Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer

“…However, in their trial, Fujitani and colleagues did not consider the possibility of a complete surgical resection of both gastric cancer and metastases, limiting their comparison between chemotherapy alone versus gastrectomy plus chemotherapy in the metastatic setting. The recent literature [6][7][8][9][10][11][12][13][14][15] contrasts with the conclusion of the REGATTA Trial, showing that an integrated multidisciplinary approach including chemotherapy and surgery may offer, at least to a selected subgroup of patients, unexpected results, in particular when a radical (R0) resection can be achieved both on gastric primary and metastases. Although the power of these studies is limited by their retrospective nature, they cannot be ignored, particularly in the light of results achieved by conversion therapy.…”

“…Our previous studies [6,[9][10][11] focused on hepatic metastases and endorsed an aggressive integrated approach including surgery for selected patients, on the theoretical assumption that hepatic metastasis may still characterize a regional and not a systemic disease, and thus display a better prognosis, since the liver plays a "first-filter" role for the portal bloodstream. Unexpectedly, however, expanding our evaluation to the entire cohort of metastatic patients, we did not observe better survival outcomes for patients with hepatic metastases when compared to those presenting metastatic disease in the peritoneal cavity, distant lymph nodes, extra-hepatic haematogenous locations, or any possible association of the above.…”

“…Extending our interest beyond the subset of patients affected by gastric cancer with hepatic metastases, for whom we actively endorsed the role of surgery [6,[9][10][11], we investigated the role of surgery in our entire cohort of metastatic patients. Our research had three main purposes: to compare the survival performance of palliative gastrectomy and curative resection of both gastric cancer and metastases; to evaluate whether the different presentations of the metastatic disease have the same prognostic value, as suggested by the TNM classification; and to explore whether it is possible to recognize patients to be submitted to aggressive multimodal management.…”

Isolated Pancreatic Metastases of Renal Cell Carcinoma—A Paradigm of a Seed and Soil Mechanism: A Literature Analysis of 1,034 Observations

“…For mRCC, such studies have also been presented (though without mentioning if isPM observations were included), which unanimously confirmed that the initial total tumor burden was a negative prognostic factor (231,(251)(252)(253). Metastases surgery also proved that the time of occurrence of metastases was a prognostic factor, e.g., in liver metastases surgery of colorectal cancer (248,254,255), gastric cancer (256), and breast cancer (257). After all, these parameters were also risk factors proven in RCC surgery (232, 233, 258-261), as well as in RCC metastases surgery (262)(263)(264)(265)(266)(267)(268), although the significance of these factors varied greatly depending on individual properties of primary RCC and metastasis localization and not all factors were equally effective for every metastatic localization.…”