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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgment

The authors are grateful to Mr. Richard Humphies (BA Hons English Literature) for his precious help in revising the English language of the manuscript.

Disclosure

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Authors and Affiliations

  1. Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    Guido Alberto Massimo Tiberio MD, Gian Luca Baiocchi MD, Silvia Ministrini MD & Arianna Coniglio MD

  2. Department of General Surgery, Morgagni Hospital, Forlì, Italy

    Paolo Morgagni MD & Giovanni Vittimberga MD

  3. Surgical Oncology, Department of Human Pathology and Oncology, University of Siena, Siena, Italy

    Daniele Marrelli MD & Franco Roviello MD

  4. Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy

    Alberto Marchet MD & Donato Nitti MD

  5. Division of General Surgery, University of Verona, Verona, Italy

    Chiara Cipollari MD & Giovanni de Manzoni MD

  6. General Surgery, Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Perugia, Italy

    Luigina Graziosi MD & Annibale Donini MD

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  1. Guido Alberto Massimo Tiberio MD
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  2. Gian Luca Baiocchi MD
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  13. Arianna Coniglio MD
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  14. Giovanni de Manzoni MD
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Corresponding author

Correspondence to Guido Alberto Massimo Tiberio MD.

Additional information

On behalf of the Italian Research Group for Gastric Cancer.

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Supplementary material 1 (DOC 84 kb)

Supplementary material 2 (DOCX 18 kb)

Supplementary Fig. 1

Effect 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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Tiberio, G.A.M., Baiocchi, G.L., Morgagni, P. et al. Gastric Cancer and Synchronous Hepatic Metastases: Is It Possible to Recognize Candidates to R0 Resection?. Ann Surg Oncol 22, 589–596 (2015). https://doi.org/10.1245/s10434-014-4018-6

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  • DOI: https://doi.org/10.1245/s10434-014-4018-6

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