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

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

doi:10.1245/s10434-014-4018-6

Cited by 59 publications

(63 citation statements)

References 28 publications

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“…Those results were maintained after propensity matching for the differences between groups. Other publications from the Far East [4][5][6][7], and some Western centers [14][15][16][17], have also suggested the safety of hepatectomy for gastric cancer liver metastases in selected patients. The results of this study also parallel the outcomes of hepatectomy for colorectal cancer liver metastases, where surgical resection is more common and is considered the standard of care for isolated hepatic metastases [11].…”

Section: Discussionmentioning

confidence: 99%

Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England

et al. 2016

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Background The objectives of this national study were to examine the short-term safety and long-term survival benefit associated with surgical resection of hepatic metastases from gastric cancer. Methods Patients from the Hospital Episode Statistics database were classified by disease and treatment approach. Gastric cancer: 1. Without liver metastases treated by gastrectomy (GG). 2. With liver metastases treated by gastrectomy and hepatectomy (GGH). 3. With liver metastases treated by gastrectomy without hepatectomy (GGNH). 4. With liver metastases treated with no surgery (GNS). Propensity score matching and multivariable analyses were used to compensate for differences in some baseline characteristics. Results During the study period, 87,482 were patients diagnosed with gastric cancer, of whom 13,841 underwent partial or total gastrectomy. Of those who underwent gastrectomy, 336 had a diagnosis of liver metastases and 78 of these had a hepatectomy. Propensity-matched analysis showed no significant differences in 30-or 90-day mortality between the GGH and GG groups. The GGH group had significantly improved 1-year mortality (35.9 % vs. 50.0 %, p = 0.049) and 5-year mortality (61.5 % vs. 75.7 %, p = 0.031) compared to the GGNH group, and compared to the GNS group, the GCH group had 1-year mortality (35.9 % vs. 84.6 %, p \ 0.001) and 5-year mortality (61.5 % vs. 90.8 %, p \ 0.001). Conclusions This study showed that hepatectomy for synchronous gastric cancer hepatic metastases may carry survival benefits in selected patients. The data presented should not be a rationale to change current clinical practice but rather a stimulus to prospectively study the role of surgery in a selected group of patients who are currently treated with palliative chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England

et al. 2016

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“…Recent results of the REGATTA trial, conducted in Asian patients, did not show any survival benefit of gastrectomy followed by chemotherapy compared with chemotherapy alone in advanced GC with a single noncurable factor, with an overall 2-year survival of 31.7 % for patients treated with chemotherapy alone versus 25.1 % for those treated with gastrectomy plus chemotherapy [33]. Palliative gastrectomy associated with liver resection and chemotherapy, when R0 resection can be obtained in patients able to endure difficult surgery, has been reported to improve overall survival in selected groups of patients [34].…”

Section: Palliationmentioning

confidence: 99%

The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015

et al. 2016

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“…We reviewed the 7 largest studies reported from 2012 to 2017, each with ≥ 50 patients who underwent hepatectomy for liver metastases from gastric cancer [12][13][14][15][16][17] [ Table 1]. In these series, the 3-and 5-year OS rates were 14.0% to 51.4% and 9.3% to 42.3%, respectively, with a median survival time (MST) of 13.0 to 40.8 months [12][13][14][15][16][17][18] . Solitary metastasis or a small number of metastatic nodules was highlighted as a favorable prognosis in most of the studies.…”

Section: Liver Metastasesmentioning

confidence: 99%

Conversion surgery for stage IV gastric cancer

Ida¹,

Watanabe²

2018

JCMT

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Gastric cancer with distant metastases, such as para-aortic lymph node metastases, hepatic metastases, and peritoneal dissemination, is classified as stage IV. In this situation, cancer cells have formed micrometastases throughout the body; therefore, according to the algorithm of the Japanese guidelines, stage IV cancer is outside the indication for curative resection. Recent advances in some chemical agents have been remarkable, and some patients have survived for long periods even with stage IV gastric cancer. Thus, even in patients with stage IV gastric cancer, there is a possibility that gastrectomy as conversion surgery could play an important role in the treatment strategy. Gastrectomy as conversion therapy can be safely conducted without perioperative mortality and is considered a sufficiently acceptable treatment strategy. However, the significance of conversion surgery for stage IV gastric cancer remains controversial. In this review, we summarize the treatment strategies and outcomes of conversion surgery for stage IV gastric cancer.

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

Abstract: 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.

Cited by 59 publications

References 28 publications

Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England

Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England

The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015

Conversion surgery for stage IV gastric cancer

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