Abstract
Few patients with metastatic gastric cancer have disease that is amenable to curative surgery. Thus far, little is known about liver surgery for metastases arising from gastric adenocarcinoma and prognostic factors. Of 73 patients operated on between 1980 and 1999 for noncolorectal, non-neuroendocrine hepatic metastases, 15 underwent liver resection for gastric adenocarcinoma metastasis. Ten patients underwent synchronous hepatic resection and five underwent metachronous hepatic surgery after a median diseasefree interval of 10 months (range 6.1 to 47.3 months). None of the patients died within the first 30 days after surgery, and the in-hospital mortality rate was 6.7%. Among patients in the synchronous group, 26.7% experienced major complications mainly associated with gastric surgery. Overall median survival was 8.8 months (range 4 to 51 months); two patients survived more than 3 years. Univariate analysis reealed that the appearance of liver metastasis synchronous vs. metachronous), the distribution of liver metastases (unilobar vs. bilobar), and the primary tumor site (proximal vs. distal) were marginally signifiant predictive factors regarding overall survival. Because of its high morbidity, synchronous liver resecion for metastases originating from gastric adenocarcinoma is rarely followed by survival longer than 2 years. Primary tumor localization within the proximal third of the stomach and bilobar liver involvement appear to be predictive of poor outcome. On the other hand, curative resection of metachronous liver metastases may allow long-term survival in selected patients.
Similar content being viewed by others
References
Alexander HR, Kelsen DG, Tepper JC. Cancer of the stomach. In DeVita VD, Hellman S, Rosenberg SA, eds. Cancer. Principles and Practice of Oncology. Philadelphia: Lippincott-Raven, 1997, pp 1021–1040.
Habu H, Saito N, Sato Y, Takeshita K, Sunagawa M, Endo M. Results of surgery in patients with gastric cancer extending to the adjacent organs. Hepatogastroenterology 1990; 37:417–420.
Okuyama K, Isono K, Juan IK, Onoda S, Ochiai T, Yamamoto Y, Koide Y, Sato H. Evaluation of treatment for gastric cancer with liver metastasis. Cancer 1985;55:2498–2505.
Wolf RF, Goodnight JE, Krag DE, Schneider PD. Results of resection and proposed guidelines for patient selection in instances of noncolorectal hepatic metastases. Surg Gynecol Obstet 1991;173:454–460.
FunovicsJM, Wenzl E, Függer R, Schemper M. Leberresektionen wegen hämatogener und infiltrierender Metastasen. Wien Klin Wochenschr 1986;24:813–820.
Harrison LE, Brennan MF, Newman E, Fortner JG, Picardo A, Blumgart LH, Fong Y. Hepatic resection for noncolorectal, nonneuroendocrine metastases: A fifteen-year experience with ninety-six patients. Surgery 1997;121:625–632.
Schlag PM, Hünerbein M, Hohenberger P. Surgical resection of metastatic cancer to the liver. Acta Chir Austria 1996;28:27–32.
Seifert JK, Junginger T. Leberresektionen bei Metastasen nicht-colorectaler Primärtumoren. Chirurg 1996;67:161–168.
Castaing D, Emond J, Kunstlinger F, Bismuth H. Utility of operative ultrasound in the surgical management of liver tumors. Ann Surg 1986;204:600–605.
Rifkin MD, Rosato FE, Branch HM, Foster J, Yang S, Barbot DJ, Marks GJ. Intraoperative ultrasound of the liver. An important tool of decision making in the operating room. Ann Surg 1987;205:466–472.
Schmidt J, Strotzer M, Fraunhofer S, Boedeker H, Zirngibl H. Intraoperative ultrasonography versus helical computed tomography and computed tomography with arterioportography in diagnosing colorectal liver metastases: Lesion-bylesion analysis. World J Surg 2000;24:43–47.
Zacherl J, Scheuba C, Imhof M, Zacherl M, Längle F, Pokieser P, Wrba F, Wenzl E, Mühlbacher F, Steininger R. The current value of intraoperative sonography in surgery for hepatic neoplasms. World J Surg (in press).
Adam YG, Efron G. Trends and controversies in the management of carcinoma of the stomach. Surg Gynecol Obstet 1989;169:371–385.
Ochiai T, Sasako M, Mizuno S, Kinoshita T, Takayama T, Kosegue T, Yamazaki S, Maruyama K. Hepatic resection for metastatic tumours from gastric cancer: Analysis of prognostic factors. BrJ Surg 1994;81:1175–1178.
Taniguchi H, Takahashi T, Sawai. K, Yamaguchi T, Hagiwara A, Kitamura K, Hoshima M, Masuyama M, Mugitani T, Takada A, Yamaguchi A. Comparison in survival between hepatic metastases of gastric and colorectal cancers. Hepatogastroenterology 1997;44:897–900.
Berney T, Mentha G, Roth AD, Morel P. Results of surgical resection of liver metastases from non-colorectal primaries. Br J Surg 1998;85:1423–1427.
Blumgart LH, Allison DJ. Resection and embolisation in the management of secondary hepatic tumors. World J Surg 1982;6:32–45.
Lindell G, Ohlsson B, Saarela A, Andersson R, Tranberg KG. Liver resection of noncolorectal secondaries. J Surg Oncol 1998;69:66–70.
Scheele J. Hepatectomy for liver metastases. Br J Surg 1993;80:274–276.
Akamo Y, Takeyama H, Mohri N, Teranishi S, Manabe T. Retrospective study on patients with metachronous liver metastasis of gastric carcinoma after curative resection. Third International Gastric Cancer Congress, Seoul, Korea, 1999, FP-14–115.
Miyazaki M, Itoh H, Nakagawa K, Ambiru S, Shimizu H, Togawa A, Shiobara M, Ohtsuka M, Sasada K, Shimizu Y, Yoshioka S, Nakajima N, Suwa T, Kimura F. Hepatic resection of liver metastases from gastric carcinoma. Am J Gastroenterol 1997;92:490–493.
Rafique M, Adachi W, Kajikawa S, Kobayashi M, Koike S, Kuroda T. Management of gastric cancer patients with synchronous hepatic metastasis: A retrospective study. Hepatogastroenterology 1995;42:666–671.
Elias D, Cavalcanti de Albuquerque A, Eggenspieler P, Plaud B, Ducreux M, Spielmann M, Theodore C, Bonvalot S, Lasser P. Resection of liver metastases from a noncolorectal primary: Indications and results based on 147 monocentric patients. J Am Coll Surg 1998;187:487–493.
Bines SD, England G, Deziel DJ, Witt TR, Doolas A, Roseman DL. Synchronous, metachronous, and multiple hepatic resections of liver tumors originating from primary gastric tumors. Surgery 1993;114:799–805.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zacherl, J., Zacherl, M., Scheuba, C. et al. Analysis of hepatic resection of metastasis originating from gastric adenocarcinoma. J Gastrointest Surg 6, 682–689 (2002). https://doi.org/10.1016/S1091-255X(01)00075-0
Issue Date:
DOI: https://doi.org/10.1016/S1091-255X(01)00075-0