World Journal of Surgery

, Volume 37, Issue 11, pp 2664–2670 | Cite as

Repeat Hepatectomy for Recurrent Liver Metastasis From Gastric Carcinoma

  • Nobuyuki Takemura
  • Akio Saiura
  • Rintaro Koga
  • Ryuji Yoshioka
  • Junji Yamamoto
  • Norihiro Kokudo



The efficacy of repeat hepatectomy for recurrent hepatocellular carcinoma and colorectal liver metastases is widely accepted. However, the benefits of such treatment for intrahepatic recurrence of gastric cancer liver metastasis remain unknown. This study sought to clarify the survival benefit for patients undergoing repeat hepatectomy for gastric cancer liver metastasis.


A total of 73 patients underwent hepatectomy for gastric cancer liver metastasis from January 1993 to January 2011. Macroscopically curative surgery was performed in 64 patients. Among them, repeat hepatectomy was performed in 14 of the 37 patients with intrahepatic recurrence. Among these 14 patients, clinicopathologic factors were evaluated by univariate and multivariate analysis to identify the factors affecting survival.


The overall 1-, 3-, and 5-year survival rates after a second hepatectomy were 71, 47, and 47 %, respectively. The median survival was 31 months. Operative morbidity and mortality rates of repeat hepatectomy were 29 and 0 %, respectively. Multivariate analysis identified the duration of the disease-free interval as the only independent significant factor predicting better survival.


In selected patients, repeat hepatectomy for recurrent gastric cancer liver metastasis may offer the same chance of cure as the primary hepatectomy. Disease-free intervals exceeding 12 months predict good patient survival after repeat hepatectomy.


Gastric Cancer Good Supportive Care Metastatic Gastric Cancer Intrahepatic Recurrence Hepatic Arterial Infusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported in part by the National Cancer Center Research and Development Fund (23-A-14).

Conflict of interest

The authors have no conflict of interest to declare.


  1. 1.
    Ferlay J, Shin HR, Bray F et al (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917PubMedCrossRefGoogle Scholar
  2. 2.
    Koga S, Kawaguchi H, Kishimoto H et al (1980) Therapeutic significance of noncurative gastrectomy for gastric cancer with liver metastasis. Am J Surg 140:356–359PubMedCrossRefGoogle Scholar
  3. 3.
    Okuyama K, Isono K, Juan IK et al (1985) Evaluation of treatment for gastric cancer with liver metastasis. Cancer 55:2498–2505PubMedCrossRefGoogle Scholar
  4. 4.
    Okano K, Maeba T, Ishimura K et al (2002) Hepatic resection for metastatic tumors from gastric cancer. Ann Surg 235:86–91PubMedCrossRefGoogle Scholar
  5. 5.
    Douglass HO Jr, Hundahl SA, Macdonald JS et al (2007) Gastric cancer: D2 dissection or low Maruyama index-based surgery—a debate. Surg Oncol Clin N Am 16:133–155PubMedCrossRefGoogle Scholar
  6. 6.
    Koga R, Yamamoto J, Ohyama S et al (2007) Liver resection for metastatic gastric cancer: experience with 42 patients including eight long-term survivors. Jpn J Clin Oncol 37:836–842PubMedCrossRefGoogle Scholar
  7. 7.
    Minagawa M, Makuuchi M, Takayama T et al (2003) Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 238:703–710PubMedCrossRefGoogle Scholar
  8. 8.
    Wu CC, Cheng SB, Yeh DC et al (2009) Second and third hepatectomies for recurrent hepatocellular carcinoma are justified. Br J Surg 96:1049–1057PubMedCrossRefGoogle Scholar
  9. 9.
    Griffith KD, Sugarbaker PH, Chang AE (1990) Repeat hepatic resections for colorectal metastases. Surgery 107:101–104PubMedGoogle Scholar
  10. 10.
    Huguet C, Bona S, Nordlinger B et al (1990) Repeat hepatic resection for primary and metastatic carcinoma of the liver. Surg Gynecol Obstet 171:398–402PubMedGoogle Scholar
  11. 11.
    Nordlinger B, Vaillant JC (1994) Repeat resections for recurrent colorectal liver metastases. Cancer Treat Res 69:57–61PubMedCrossRefGoogle Scholar
  12. 12.
    Adam R, Bismuth H, Castaing D et al (1997) Repeat hepatectomy for colorectal liver metastases. Ann Surg 225:51–60PubMedCrossRefGoogle Scholar
  13. 13.
    Ochiai T, Sasako M, Mizuno S et al (1994) Hepatic resection for metastatic tumours from gastric cancer: analysis of prognostic factors. Br J Surg 81:1175–1178PubMedCrossRefGoogle Scholar
  14. 14.
    Miyazaki M, Itoh H, Nakagawa K et al (1997) Hepatic resection of liver metastases from gastric carcinoma. Am J Gastroenterol 92:490–493PubMedGoogle Scholar
  15. 15.
    Ambiru S, Miyazaki M, Ito H et al (2001) Benefits and limits of hepatic resection for gastric metastases. Am J Surg 181:279–283PubMedCrossRefGoogle Scholar
  16. 16.
    Saiura A, Umekita N, Inoue S et al (2002) Clinicopathological features and outcome of hepatic resection for liver metastasis from gastric cancer. Hepatogastroenterology 49:1062–1065PubMedGoogle Scholar
  17. 17.
    Sakamoto Y, Ohyama S, Yamamoto J et al (2003) Surgical resection of liver metastases of gastric cancer: an analysis of a 17-year experience with 22 patients. Surgery 133:507–511PubMedCrossRefGoogle Scholar
  18. 18.
    Shirabe K, Shimada M, Matsumata T et al (2003) Analysis of the prognostic factors for liver metastasis of gastric cancer after hepatic resection: a multi-institutional study of the indications for resection. Hepatogastroenterology 50:1560–1563PubMedGoogle Scholar
  19. 19.
    Adam R, Chiche L, Aloia T et al (2006) Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1,452 patients and development of a prognostic model. Ann Surg 244:524–535PubMedCrossRefGoogle Scholar
  20. 20.
    Sakamoto Y, Sano T, Shimada K et al (2007) Favorable indications for hepatectomy in patients with liver metastasis from gastric cancer. J Surg Oncol 95:534–539PubMedCrossRefGoogle Scholar
  21. 21.
    Takemura N, Saiura A, Koga R et al (2012) Long-term outcomes after surgical resection for gastric cancer liver metastasis: an analysis of 64 macroscopically complete resections. Langenbecks Arch Surg 397:915–957CrossRefGoogle Scholar
  22. 22.
    Lordick F (2012) To resect or not resect in metastatic gastric cancer: that is the question! Gastric Cancer 15:229–231PubMedCrossRefGoogle Scholar
  23. 23.
    Sarela AI, Yelluri S (2007) Gastric adenocarcinoma with distant metastasis: is gastrectomy necessary? Arch Surg 142:143–149PubMedCrossRefGoogle Scholar
  24. 24.
    Boku N, Yamamoto S, Fukuda H et al (2009) Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 study. Lancet Oncol 10:1063–1069PubMedCrossRefGoogle Scholar
  25. 25.
    Koizumi W, Narahara H, Hara T et al (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9:215–221PubMedCrossRefGoogle Scholar
  26. 26.
    Bang YJ, Van Cutsem E, Feyereislova A et al (2010) Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 376:687–697PubMedCrossRefGoogle Scholar
  27. 27.
    Cunningham D, Okines AF, Ashley S (2010) Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 362:858–859PubMedCrossRefGoogle Scholar
  28. 28.
    Hirasawa T, Asahara S, Fujisaki S et al (2008) Transcatheter arterial chemoembolization (TACE) using degradable starch microspheres (DSM) for metastatic liver tumors in patients with gastric cancer. Nihon Shokakibyo Gakkai Zasshi 105:367–372 (in Japanese)PubMedGoogle Scholar
  29. 29.
    Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12:351–355PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Nobuyuki Takemura
    • 1
  • Akio Saiura
    • 1
  • Rintaro Koga
    • 1
  • Ryuji Yoshioka
    • 1
  • Junji Yamamoto
    • 2
  • Norihiro Kokudo
    • 3
  1. 1.Department of Gastroenterological SurgeryCancer Institute Ariake Hospital, Japanese Foundation for Cancer ResearchKoto-kuJapan
  2. 2.Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
  3. 3.Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of MedicineUniversity of TokyoTokyoJapan

Personalised recommendations