Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 8, 2020; 11(5): 110-122
Published online Nov 8, 2020. doi: 10.4292/wjgpt.v11.i5.110
Do liver metastases from gastric cancer contraindicate aggressive surgical resection? A 14-year single-center experience
Takefumi Yazawa, Tomohide Hori, Hidekazu Yamamoto, Hideki Harada, Michihiro Yamamoto, Masahiro Yamada, Masaki Tani, Asahi Sato, Yasuyuki Kamada, Ryotaro Tani, Ryuhei Aoyama, Yudai Sasaki, Masazumi Zaima
Takefumi Yazawa, Tomohide Hori, Hidekazu Yamamoto, Hideki Harada, Michihiro Yamamoto, Masahiro Yamada, Masaki Tani, Asahi Sato, Yasuyuki Kamada, Ryotaro Tani, Ryuhei Aoyama, Yudai Sasaki, Masazumi Zaima, Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
Author contributions: Yazawa T collected the data; Yazawa T and Hori T analyzed the data and wrote this report; Yazawa T and Hori T contributed equally to this work; Zaima M and Hori T supervised this report; all authors discussed therapeutic options, reviewed previous papers, and provided important opinions.
Institutional review board statement: This report was approved by the Institutional Review Board of Shiga General Hospital, Moriyama, Japan.
Informed consent statement: The patients involved in this study provided written informed consent authorizing the use and disclosure of their protected health information.
Conflict-of-interest statement: Neither author has a potential conflict of interest.
Data sharing statement: Data in this report were retrospectively evaluated.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Tomohide Hori, FACS, MD, PhD, Associate Professor, Attending Doctor, Doctor, Surgeon, Department of Surgery, Shiga General Hospital, 5-4-30 Moriyama, Moriyama 524-8524, Shiga, Japan. horitomo55office@yahoo.co.jp
Received: March 4, 2020
Peer-review started: March 4, 2020
First decision: April 12, 2020
Revised: April 27, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: November 8, 2020
Abstract
BACKGROUND

Advanced gastric cancer (GC) with liver metastasis is often characterized by multiple and bilobular metastases and may also be associated with extrahepatic metastatic lesions. Hence, many physicians consider that radical surgeries are contraindicated for liver metastases from GC (LMGC). According to the 2017 Japanese treatment guideline for GC, a smaller number of liver metastases without unresectable factors may be an indication for liver resection (LR) with curability. The actual 5-year overall survival (OS) rate ranges from 0 to 0.37.

AIM

To present the institutional indications for LR for LMGC and identify important factors for prognostic outcomes.

METHODS

In total, 30 patients underwent LR for LMGC during a 14-year period, and we evaluated the clinical, surgical, and oncological findings. In all patients, radical surgery with intentional lymphadenectomy was performed for the primary GC. The median follow-up duration after the initial LR was 33.7 mo, and three patients with no recurrence died of causes unrelated to the LMGC. The OS and recurrence-free survival rates after the initial LR were assessed.

RESULTS

Seventeen patients had metachronous LMGC. The initial LR achieved curability in 29 patients. Perioperative chemotherapy was introduced in 23 patients. The median greatest LMGC dimension was 30 mm, and the median number of LMGC was two. Twenty-two patients had unilobular LMGC. The 5-year OS and recurrence-free survival rates were 0.48 and 0.28, respectively. The median survival duration and recurrence-free duration after the initial LR were 16.8 and 8.6 mo, respectively. Twenty-one patients developed recurrence after the initial LR. Additional surgeries for recurrence were performed in nine patients, and these surgeries clearly prolonged the patients’ survival. Pathological serosal invasion was an independent predictor of a poor prognostic outcome after the initial LR. Aggressive LR may be indicated for carefully selected patients with LMGC.

CONCLUSION

Our results of LR for LMGC seem acceptable. Additional surgeries for recurrence after the initial LR might prolong OS. Pathological serosal invasion is important for poor prognostic outcomes.

Keywords: Liver metastasis, Metastatic tumor, Gastric cancer, Hepatectomy, Liver resection, Surgery

Core Tip: The indication for liver resection (LR) for liver metastases from gastric cancer (LMGC) is still controversial. In the present study, the institutional indications for LR for LMGC are shown in detail. The 5-year overall survival rate was 0.48, and our results of LR for LMGC seemed to be acceptable. Although recurrence might develop after the initial LR, additional surgeries for recurrence clearly prolong survival. Pathological serosal invasion of the primary gastric cancer was an independent predictor of poor prognostic outcomes after the initial LR. Aggressive LR may be indicated for carefully selected patients with LMGC.