Annals of Surgical Oncology

, Volume 22, Issue 2, pp 589–596 | Cite as

Gastric Cancer and Synchronous Hepatic Metastases: Is It Possible to Recognize Candidates to R0 Resection?

  • Guido Alberto Massimo Tiberio
  • Gian Luca Baiocchi
  • Paolo Morgagni
  • Daniele Marrelli
  • Alberto Marchet
  • Chiara Cipollari
  • Luigina Graziosi
  • Silvia Ministrini
  • Giovanni Vittimberga
  • Annibale Donini
  • Donato Nitti
  • Franco Roviello
  • Arianna Coniglio
  • Giovanni de Manzoni
Gastrointestinal Oncology

Abstract

Purpose

Management of patients with synchronous hepatic metastases as the sole metastatic site at diagnosis of gastric cancer is debated. We studied a cohort of patients admitted to surgical units, investigating prognostic factors of clinical relevance and the results of various therapeutic strategies.

Methods

Retrospective multicentre chart review. We evaluated how survival from surgery was influenced by patient-related, gastric cancer-related, metastasis-related and treatment-related candidate prognostic factors.

Results

Forty-four patients received palliative surgery without resection, 98 palliative gastrectomy (in 16 cases associated with R+ hepatectomy), whereas 53 patients received both curative gastrectomy and hepatic resection(s) (R0). Adjuvant chemotherapy was administered to 44 patients. Therapeutic approach was selected on the basis of extension of disease, patient’s general conditions and surgeon’s attitude. Surgical mortality was 4.6 % and morbidity was 17.4 %. Survival was independently influenced by the factor T of the gastric primary (p = 0.036) and by the degree of hepatic involvement (p = 0.010). T > 2 and H3 liver involvement were associated with worse prognosis with cumulative effect (p = 0.002). Therapeutic approach to the metastases (p = 0.009) and adjuvant chemotherapy (p < 0.001) displayed independent impact upon survival, with benefit for those receiving aggressive multimodal treatment. The 1-, 3-, and 5-year survival rates were 50.4, 14.0, and 9.3 %, respectively, for patients submitted to curative surgery, 16, 8.5, and 4.3 % after palliative gastrectomy, and 6.8, 2.3, and 0 % after palliative surgery without resection.

Conclusions

Our data suggest some clinical criteria that may facilitate selection of candidates to curative surgery, which offers the best survival chances, especially when associated with adjuvant chemotherapy.

Supplementary material

10434_2014_4018_MOESM1_ESM.doc (84 kb)
Supplementary material 1 (DOC 84 kb)
10434_2014_4018_MOESM2_ESM.docx (18 kb)
Supplementary material 2 (DOCX 18 kb)
10434_2014_4018_MOESM3_ESM.tif (60 kb)
Supplementary Fig. 1Effect of chemotherapy. A Survival according to chemotherapy. B Cumulative survival according to the number of negative prognostic factors related to gastric primary (T > 2) and hepatic involvement (H3). Supplementary material 3 (TIFF 60 kb)

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Guido Alberto Massimo Tiberio
    • 1
  • Gian Luca Baiocchi
    • 1
  • Paolo Morgagni
    • 2
  • Daniele Marrelli
    • 3
  • Alberto Marchet
    • 4
  • Chiara Cipollari
    • 5
  • Luigina Graziosi
    • 6
  • Silvia Ministrini
    • 1
  • Giovanni Vittimberga
    • 2
  • Annibale Donini
    • 6
  • Donato Nitti
    • 4
  • Franco Roviello
    • 3
  • Arianna Coniglio
    • 1
  • Giovanni de Manzoni
    • 5
  1. 1.Surgical Clinic, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
  2. 2.Department of General SurgeryMorgagni HospitalForlìItaly
  3. 3.Surgical Oncology, Department of Human Pathology and OncologyUniversity of SienaSienaItaly
  4. 4.Department of Oncological and Surgical SciencesUniversity of PadovaPadovaItaly
  5. 5.Division of General SurgeryUniversity of VeronaVeronaItaly
  6. 6.General Surgery, Department of Surgical Sciences, Radiology and DentistryUniversity of PerugiaPerugiaItaly

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