Surgical resection of hepatic metastasis from gastric cancer: a review and new recommendation in the Japanese gastric cancer treatment guidelines

Kodera, Yasuhiro; Fujitani, Kazumasa; Fukushima, Noriyoshi; Ito, Seiji; Muro, Kei; Ohashi, Norifumi; Yoshikawa, Takaki; Kobayashi, Daisuke; Tanaka, Chie; Fujiwara, Michitaka

doi:10.1007/s10120-013-0299-x

Cited by 111 publications

(95 citation statements)

References 38 publications

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“…For patients with liver metastasis from gastric cancer, palliative treatment is regarded the standard of care, since their disease is incurable and their life expectancy is dreadfully short. To improve survival, various liver-directed treatment strategies for liver metastasis from gastric cancer, in combination with systemic chemotherapy, have been applied, such as surgical resection, radiofrequency ablation (RFA), and hepatic artery infusion chemotherapy [7][8][9][10][11]. Meanwhile, for liver metastases from colorectal cancer and neuroendocrine tumors, surgical resection is the treatment of choice [12,13].…”

Section: And Woo Jin Hyungmentioning

confidence: 99%

Liver-directed treatments for liver metastasis from gastric adenocarcinoma: comparison between liver resection and radiofrequency ablation

et al. 2015

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Background Although various liver-directed treatment modalities, such as liver resection and radiofrequency ablation (RFA), have been applied to treat liver metastases from gastric cancer, optimal management of them remains controversial. In patients with liver metastasis from gastric cancer, we investigated the short-and long-term outcomes of liver resection and RFA and analyzed factors influencing survival. Methods A total of 98 gastric cancer patients with liver metastasis and no extrahepatic disease were treated by liver resection (n = 68) or RFA (n = 30). Short-and long-term outcomes were evaluated retrospectively for each of the liver-directed treatments. Results Severe complication rates did not differ between liver resection (18 %) and RFA (10 %) (p = 0.333). Only one treatment-related mortality occurred in the liver resection group. No statistically significant difference in survival was noted between the treatment groups. Median overall survival after liver resection was 24 months, with 3-year overall and progression-free survival rates of 40.6 % and 30.4 %, respectively. Median overall survival after RFA was 23 months, with 3-year overall and progression-free survival rates of 43.0 % and 37.4 %, respectively. Only the size of the metastases was shown to be an independent prognostic factor for gastric cancer patients with liver metastasis. Conclusions In select patients with liver metastasis from gastric cancer, liver resection and RFA showed satisfactory and comparable short-and long-term results. Thus, systemic chemotherapy may not be the only therapeutic option for patients with liver metastasis, and possible liver-directed treatment options for such patients should be considered on an individual basis.

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Section: And Woo Jin Hyungmentioning

confidence: 99%

Liver-directed treatments for liver metastasis from gastric adenocarcinoma: comparison between liver resection and radiofrequency ablation

et al. 2015

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“…By contrast, colorectal liver metastases are widely considered as targets of surgery with an intent to cure because they often present as liver-only diseases, and R0 resection showed favorable survival in a recent clinical study [8]. Recently, the Guidelines Committee of the Japan Gastric Cancer Association reconsidered the treatment of potentially resectable M1 disease [9], on the basis of a report that showed favorable results in resectable liver metastases [10][11][12][13][14][15][16][17][18][19][20]. Therefore, the importance of liver resection for liver metastasis must be thoroughly analyzed.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of liver metastasis of gastric cancer: a retrospective multicenter cohort study (KSCC1302)

et al. 2015

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Background The necessity of surgical treatment of liver metastases of gastric cancer is still controversial. Patients and methods We conducted a multicenter retrospective cohort study of liver-limited metastasis of gastric cancer treated surgically between 2000 and 2010. In this study, 103 patients were registered, with nine patients excluded from the analysis as they did not meet the eligibility criteria.Results Of the 94 patients, 69 underwent surgical resection, 11 underwent surgical resection combined with radiofrequency ablation or microwave coagulation therapy for small or deep tumors, and 14 underwent radiofrequency ablation or microwave coagulation therapy only. Synchronous and metachronous metastases were found in 37 and 57 patients, respectively. The 3-and 5-year overall survival rates of all the patients were 51.4 and 42.3 %, respectively. The 3-and 5-year relapse-free survival rates were 29.2 and 27.7 %, respectively. No significant difference in prognosis was observed between the patients who underwent surgical resection and those who underwent ablation therapy. The patients with hepatic solitary lesions and low-grade lymph node metastases of primary gastric cancer had significantly better overall survival and relapsefree survival. Conclusions To our knowledge, this study is the largest series and first multicenter cohort study of liver-limited metastasis of gastric cancer. The study indicated that patients with a single liver metastasis with a grade lower than N2 lymph node metastasis of the primary lesion are the best candidates for liver resection.

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“…Gastrectomy in Eastern centers is associated with improved long-term survival compared to the West after controlling for disease stage and patient demographics [3]. Furthermore, in Eastern centers more attention has been given to the surgical treatment of liver metastases from gastric cancer [4][5][6][7] and toward gastrectomy as a reduction surgical strategy in the presence of a single noncurable factor that showed no survival improvement over chemotherapy alone [8].…”

Section: Introductionmentioning

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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Surgical resection of hepatic metastasis from gastric cancer: a review and new recommendation in the Japanese gastric cancer treatment guidelines

Cited by 111 publications

References 38 publications

Liver-directed treatments for liver metastasis from gastric adenocarcinoma: comparison between liver resection and radiofrequency ablation

Liver-directed treatments for liver metastasis from gastric adenocarcinoma: comparison between liver resection and radiofrequency ablation

Surgical treatment of liver metastasis of gastric cancer: a retrospective multicenter cohort study (KSCC1302)

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

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