Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2015; 21(41): 11489-11492
Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11489
Hepatic metastases from gastric cancer: A surgical perspective
Guido Alberto Massimo Tiberio, Franco Roviello, Annibale Donini, Giovanni de Manzoni, the Italian Research Group for Gastric Cancer
Guido Alberto Massimo Tiberio, Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy
Franco Roviello, Surgical Oncology, Department of Human Pathology and Oncology, University of Siena, 53010 Siena, Italy
Annibale Donini, Division of General Surgery, Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, 06010 Perugia, Italy
Giovanni de Manzoni, General Surgery, University of Verona, 37010 Verona, Italy
Author contributions: Tiberio GAM, Roviello F, Donini A and de Manzoni G contributed equally to the conception, development of cultural contents and revision of this work; and Tiberio GAM wrote the text.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guido Alberto Massimo Tiberio, Professor of Surgery, Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia, 1, Piazzale Spedali Civili, 25100 Brescia, Italy. guido.tiberio@libero.it
Telephone: +39-335-8159298 Fax: +39-30-3397476
Received: May 21, 2015
Peer-review started: May 23, 2015
First decision: June 2, 2015
Revised: July 9, 2015
Accepted: September 15, 2015
Article in press: September 15, 2015
Published online: November 7, 2015

Management of patients with hepatic metastases as the sole metastatic site at diagnosis of gastric cancer (synchronous setting) or detected during follow-up (metachronous) is controversial. The prevailing attitude in these cases is passive, leading to surgical palliation and, possibly, to chemotherapy. Authors focused this editorial in order to promote a more pragmatic attitude. They stress the importance of recognizing the good candidates to curative surgery of both gastric cancer and hepatic metastases (synchronous setting) or hepatic disease alone (metachronous disease) from those who will not benefit from surgical therapy. In fact, in adequately selected subgroup of patients surgery, especially if integrated in multimodal therapeutic strategies, may achieve unexpected 5-year survival rates, ranging from 10% to 40%. The critical revision of the literature suggests that some simple clinical criteria exist that may be effectively employed in patients selection. These are mainly related to the gastric cancer (factors T, N, G) and to the extent of hepatic involvement (factor H). Upon these criteria it is possible to adequately select about 50% of cases. In the remaining 50% of cases a critical discussion on a case-by-case basis is recommended, considering that among these patients some potential long-survivors exist, that survival is strictly influenced by the ablation of the tumor bulk and by multimodality treatments including chemotherapy and that in expert institutions this kind of surgery is performed with very low mortality and morbidity rates.

Keywords: Gastric cancer, Hepatic metastases, Surgical palliation, Therapeutic strategy, Hepatectomy, Selection criteria, Gastrectomy, Chemotherapy

Core tip: Authors highlight the reasons for an active attitude in case of patients with gastric cancer and hepatic metastases. They show that when the liver is the sole metastatic site it is possible to select the good candidates for surgical management of both gastric cancer and hepatic metastases and to recognize those who will not benefit from an aggressive attitude. They also show that the multidisciplinary approach to these patients is the best option.