Updates in Surgery

, Volume 70, Issue 2, pp 273–278 | Cite as

Surgical treatment of hepatic metastases from gastric cancer

  • Silvia MinistriniEmail author
  • Leonardo Solaini
  • Chiara Cipollari
  • Silvia Sofia
  • Elisabetta Marino
  • Alessia D’Ignazio
  • Maria Bencivenga
  • Guido A. M. Tiberio
Original Article
Part of the following topical collections:
  1. Gastric Cancer Surgery


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.


Gastric cancer Hepatic metastasis Curative surgery 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Research involving human participants and/or animals

The study was approved by Institutional Review Board.

Informed consent

All patients signed at the admission a consent to anonymous data treatment for retrospective studies.


  1. 1.
    Adam R, Chiche L, Aloia T et al (2006) Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1452 patients and development of a prognostic model. Ann Surg 244:524–535CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Lehner F, Ramackers W, Bektas H et al (2009) Liver resection for noncolorectal, non-neuroendocrine liver metastases—is hepatic resection justified as part of the oncosurgical treatment? Zentralbl Chir 134:430–436CrossRefPubMedGoogle Scholar
  3. 3.
    Ochiai T, Sasako M, Mizuno S et al (1994) Hepatic resection for metastatic tumours from gastric cancer: analysis of prognostic factors. Br J Surg 81:1175–1178CrossRefPubMedGoogle Scholar
  4. 4.
    Ueda K, Iwahashi M, Nakamori M et al (2009) Analysis of the prognostic factors and evaluation of surgical treatment for synchronous liver metastases from gastric cancer. Langenbecks Arch Surg 394:647–653CrossRefPubMedGoogle Scholar
  5. 5.
    Okano K, Maeba T, Ishimura K et al (2002) Hepatic resection for metastatic tumors from gastric cancer. Ann Surg 235:86–91CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Hwang S-E, Yang D-H, Kim C-Y (2009) Prognostic factors for survival in patients with hepatic recurrence after curative resection of gastric cancer. World J Surg 33:1468–1472CrossRefPubMedGoogle Scholar
  7. 7.
    Makino H, Kunisaki C, Izumisawa Y et al (2010) Indication for hepatic resection in the treatment of liver metastasis from gastric cancer. Anticancer Res 30:2367–2376PubMedGoogle Scholar
  8. 8.
    Ambiru S, Miyazaki M, Ito H et al (2001) Benefits and limits of hepatic resection for gastric metastases. Am J Surg 181:279–283CrossRefPubMedGoogle Scholar
  9. 9.
    Miyazaki M, Itoh H, Nakagawa K et al (1997) Hepatic resection of liver metastases from gastric carcinoma. Am J Gastroenterol 92:490–493PubMedGoogle Scholar
  10. 10.
    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
  11. 11.
    Sakamoto Y, Sano T, Shimada K et al (2007) Favorable indications for hepatectomy in patients with liver metastasis from gastric cancer. J Surg Oncol 95:534–539CrossRefPubMedGoogle Scholar
  12. 12.
    Thelen A, Jonas S, Benckert C et al (2008) Liver resection for metastatic gastric cancer. Eur J Surg Oncol 34:1328–1334CrossRefPubMedGoogle Scholar
  13. 13.
    Tsujimoto H, Ichikura T, Ono S et al (2010) Outcomes for patients following hepatic resection of metastatic tumors from gastric cancer. Hepatol Int 4:406–413CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Garancini M, Uggeri F, Degrate L et al (2012) Surgical treatment of liver metastases of gastric cancer: is local treatment in a systemic disease worthwhile? HPB 14:209–215CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Schildberg CW, Croner R, Merkel S et al (2012) Outcome of operative therapy of hepatic metastatic stomach carcinoma: a retrospective analysis. World J Surg 36:872–878CrossRefPubMedGoogle Scholar
  16. 16.
    Miki Y, Fujitani K, Hirao M et al (2012) Significance of surgical treatment of liver metastases from gastric cancer. Anticancer Res 32:665–670PubMedGoogle Scholar
  17. 17.
    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 397:951–957CrossRefPubMedGoogle Scholar
  18. 18.
    Liu J, Li JH, Zhai RJ et al (2012) Predictive factors improving survival after gastric and hepatic surgical treatment in gastric cancer patients with synchronous liver metastases. Chin Med J (Engl) 125:165–171Google Scholar
  19. 19.
    Tiberio GAM, Coniglio A, Marchet A et al (2009) Metachronous hepatic metastases from gastric carcinoma: a multicentric survey. Eur J Surg Oncol 35:486–491CrossRefPubMedGoogle Scholar
  20. 20.
    Tiberio GAM, Baiocchi GL, Morgagni P et al (2015) Gastric cancer and synchronous hepatic metastases: is it possible to recognize candidates to R0 resection? Ann Surg Oncol 22:589–596CrossRefPubMedGoogle Scholar
  21. 21.
    Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112. CrossRefGoogle Scholar
  22. 22.
    Marrelli D, De Stefano A, de Manzoni G et al (2005) Prediction of recurrence after radical surgery for gastric cancer: a scoring system obtained from a prospective multicenter study. Ann Surg 241:247–255CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Markar SR, Mikhail S, Malietzis G et al (2016) Influence of surgical resection of hepatic metastases from gastric adenocarcinoma on long-term survival: systematic review and pooled analysis. Ann Surg 263(6):1092–1101CrossRefPubMedGoogle Scholar
  24. 24.
    Cheon SH, Rha SY, Jeung H-C et al (2008) Survival benefit of combined curative resection of the stomach (D2 resection) and liver in gastric cancer patients with liver metastases. Ann Oncol 19:1146–1153CrossRefPubMedGoogle Scholar
  25. 25.
    Oki E, Tokunaga S, Emi Y et al (2016) Kyushu Study Group of Clinical Cancer (2015) Surgical treatment of liver metastasis of gastric cancer: a retrospective multicenter cohort study (KSCC1302). Gastric Cancer 19(3):968–976CrossRefPubMedGoogle Scholar
  26. 26.
    Chiche L, Ducreux M, Lebreton G et al (2005) Metastases hepatiques des cancers de l’estomac. In: Adam R, Chiche L (eds) Chirurgie des metastases hepatiques de cancers non colorectaux non endocrine. Monographies de l’association Franc¸aise de Chirurgie. Arnette, Paris, pp 45–49Google Scholar
  27. 27.
    Choi AH, Kim J, Chao J (2015) Perioperative chemotherapy for resectable gastric cancer: MAGIC and beyond. World J Gastroenterol 21(24):7343–7348CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Koga R, Junji Y, Shigekazu O et al (2007) Liver resection for metastatic gastric cancer: experience with 42 patients including eight long-term survivors. JJCO 37:836–842PubMedGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2018

Authors and Affiliations

  1. 1.General SurgeryUniversity of BresciaBresciaItaly
  2. 2.General SurgeryForlì HospitalForlìItaly
  3. 3.General SurgeryUniversity of VeronaVeronaItaly
  4. 4.General SurgeryUniversity of TorinoTurinItaly
  5. 5.General SurgeryUniversity of PerugiaPerugiaItaly
  6. 6.General SurgeryUniversity of SienaSienaItaly

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