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Influence of Surgical Resection of Hepatic Metastases From Gastric Adenocarcinoma on Long-term Survival: Systematic Review and Pooled Analysis

Markar SR, Mikhail S, Malietzis G, Athanasiou T, Mariette C, Sasako M, Hanna GB

Ann Surg. 2016 Jan 16. [Epub ahead of print]

Editorial comment from Professor Florian Lordick:
The pooled analysis of 39 studies, published by Markar and co-authors shows that long-term survival in stage IV M1 (hep) gastric cancer patients is achievable with hepatic resections. Morbidity associated with hepatectomy was 24% and postoperative mortality was 0%. Compared with chemotherapy alone, resection of hepatic metastases was associated with improved survival. Patients with solitary metastases had a better survival compared with multiple metastases. In contrast, metachronous versus synchronous metastases was not a significant prognostic factor. It is important to note that this study did not include patients with peritoneal metastases or other nonliver metastatic sites.
The limitation of this study is that it is a pooled analysis of mostly small case-control studies, most of them coming from East Asia. Therefore, conclusions should be drawn with caution. To validate these findings and to learn more about the value and limitations of hepatic resections in stage IV gastric cancer, JCOG in cooperation with the EORTC is now planning a prospective registration study on hepatic resections in stage IV M1 (hep) gastric cancer.



The objectives of this systematic review and pooled analysis were to examine long-term survival, morbidity, and mortality following surgical resection of gastric cancer hepatic metastases and to identify prognostic factors that improve survival.


Patients with hepatic metastases from gastric cancer are traditionally treated with palliative chemotherapy.


A systematic literature search was undertaken (1990 to 2015). Publications were included if they studied more than 10 patients undergoing hepatectomy for hepatic metastasis from gastric adenocarcinoma in the absence of peritoneal disease or other distant organ involvement. The primary outcome was the hazard ratio (HR) for overall survival. The influence of liver metastasis related factors; multiple vs single and metachronous vs synchronous upon survival was also assessed.


The median number of resections for the 39 studies included was 21 (range 10 to 64). Procedures were associated with a median 30-day morbidity of 24% (0% to 47%) and mortality of 0% (0% to 30%). The median 1-year, 3-year, and 5-year survival were 68%, 31%, and 27%, respectively. Survival was improved in Far Eastern compared with Western studies; 1-year (73% vs 59%), 3-year (34% vs 24.5%), and 5-year (27.3% vs 16.5%). Surgical resection of hepatic metastases was associated with a significantly improved overall survival (HR = 0.50; P < 0.001). Meta-analysis confirmed the additional survival benefit of solitary compared with multiple hepatic metastases (odds ratio = 0.31; P = 0.011).


The observed improved survival rates following the resection of hepatic metastasis from gastric adenocarcinoma in selected patients merit a prospective study to formally address the survival benefits and the influence on quality of life of such approach.

©PubMed Central


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