Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11489
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.
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.