Prognostic analysis of combined curative resection of the stomach and liver lesions in 30 gastric cancer patients with synchronous liver metastases

BMC Surgery, Oct 2012

Background Gastric cancer with synchronous liver metastasis remains a clinical treatment challenge. There has been a longstanding debate on the question whether surgical resection could be beneficial to long-term survival. This study is to investigate the effectiveness and prognostic factors of combined curative resection of the stomach and liver lesions in gastric cancer patients with synchronous liver metastases. Methods A total of 30 patients who underwent simultaneous curative gastric and liver resection from March 2003 to April 2008 were analyzed retrospectively. Univariate and multivariate analyses were performed to select independent factors for survival. Results The overall 1-, 2-, 3- and 5-year survival rates of 30 patients were 43.3%, 30.0%, 16.7% and 16.7%, respectively, with a median survival of 11.0 months and 5 patients still living by the time of last follow-up. Single liver metastasis (pā€‰=ā€‰0.028) and an absence of peritoneal dissemination (pā€‰=ā€‰0.007) were significantly independent prognostic factors for these gastric cancer patients with synchronous liver metastases. Major adverse events were protracted stomach paralysis in 2 patients and pulmonary infection in another 2 patients, all of whom recovered after conservative treatment. Conclusions This descriptive study without control group found that patients with solitary liver metastasis and absence of peritoneal dissemination could have better survival benefit from simultaneous curative resection of the gastric cancer and liver metastases.

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Prognostic analysis of combined curative resection of the stomach and liver lesions in 30 gastric cancer patients with synchronous liver metastases

Yan-Na Wang 0 Kun-Tang Shen 0 Jia-Qian Ling 0 Xiao-Dong Gao 0 Ying-Yong Hou 1 Xue-Fei Wang 0 Jing Qin 0 Yi-Hong Sun 0 Xin-Yu Qin 0 0 Department of General Surgery, Zhongshan Hospital of Fudan University , No 180 Fenglin Road, Shanghai 200032 , China 1 Department of Pathology, Zhongshan Hospital of Fudan University , No 180 Fenglin Road, Shanghai 200032 , China Background: Gastric cancer with synchronous liver metastasis remains a clinical treatment challenge. There has been a longstanding debate on the question whether surgical resection could be beneficial to long-term survival. This study is to investigate the effectiveness and prognostic factors of combined curative resection of the stomach and liver lesions in gastric cancer patients with synchronous liver metastases. Methods: A total of 30 patients who underwent simultaneous curative gastric and liver resection from March 2003 to April 2008 were analyzed retrospectively. Univariate and multivariate analyses were performed to select independent factors for survival. Results: The overall 1-, 2-, 3- and 5-year survival rates of 30 patients were 43.3%, 30.0%, 16.7% and 16.7%, respectively, with a median survival of 11.0 months and 5 patients still living by the time of last follow-up. Single liver metastasis (p = 0.028) and an absence of peritoneal dissemination (p = 0.007) were significantly independent prognostic factors for these gastric cancer patients with synchronous liver metastases. Major adverse events were protracted stomach paralysis in 2 patients and pulmonary infection in another 2 patients, all of whom recovered after conservative treatment. Conclusions: This descriptive study without control group found that patients with solitary liver metastasis and absence of peritoneal dissemination could have better survival benefit from simultaneous curative resection of the gastric cancer and liver metastases. - Background Liver is one of the most frequent sites of cancer metastasis from gastrointestinal origin, and the major cause of disease death from stomach cancer [1]. The 5-year survival rate could be up to 29% for metachronous liver metastasis and only 6% for synchronous liver metastasis, from gastric cancer [2]. Therefore, it has long been thought by many that surgical treatment could not bring any substantial survival benefit for gastric cancer patients with synchronous liver metastasis. However, there has also been longstanding debate on the question whether surgical resection could be beneficial to longterm survival. Some believe that if R0 resection could be performed for both gastric cancer and synchronous liver metastasis, such simultaneous resection could significantly improve survival [3,4]. On the other hand, gastric cancer patients with liver metastasis usually have multiple intrahepatic lesions, peritoneal metastasis, regional lymph nodes metastasis and adjacent organs involvements [5-7], making it questionable whether simultaneous resection could bring any survival benefit. From March 2003 to April 2008, we performed simultaneous resection of both the gastric cancer and liver metastasis on 30 patients. This study is to summarize our experience and to analyze the efficacy and prognosis on these patients. Methods The study complied with the declaration of Helsinki and was approved by Biomedical Research Ethics Committee of Zhongshan Hospital of Fudan University (NO.2009-160). All subjects gave written informed consent. Patients and treatment From March 2003 to April 2008, a total of 2942 patients with gastric cancer were treated at our institution. From the archived medical records, a complete database was established on 30 gastric cancer patients with synchronous liver metastasis, who had simultaneous complete resection of both gastric cancer and liver metastasis. The database covered all clinico-pathological characteristics. Lymph node grouping was based on Japanese classification on cancer typing [8] and TNM classification was base on AJCC 7th edition [9]. Of these 30 patients were 27 males and 3 females, with age ranging from 33 to 72 years old (median 60 yr). The primary stomach cancer was located at the antrum in 11 cases, at the gastric body in 9 cases and at the cardiafundus region in 10 cases. On local invasion status, 4 cases had tumor invasion beneath the serosa, and the remaining 26 cases all had tumor invasion beyond the serosa. On lymph nodes status, 7 cases did not have lymph nodes metastasis while the remaining 23 cases were lymph nodes positive. In terms of liver metastasis, 22 patients had one intrahepatic metastasis lesion and 8 patients had 23 liver metastases. There were 27 patients with metastasis limited to one lobe of the liver (H1), and 3 cases with metastasis on both lobes of the liver (H2). Simultaneous peritoneal metastasis was found in 5 patients. Of surgical approaches, 11 patients had curative distal gastrectomy, 10 patients had curative proximal gastrectomy and 9 cases had total gastrectomy. (...truncated)


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Yan-Na Wang, Kun-Tang Shen, Jia-Qian Ling, Xiao-Dong Gao, Ying-Yong Hou, Xue-Fei Wang, Jing Qin, Yi-Hong Sun, Xin-Yu Qin. Prognostic analysis of combined curative resection of the stomach and liver lesions in 30 gastric cancer patients with synchronous liver metastases, BMC Surgery, 2012, pp. 20, 12, DOI: 10.1186/1471-2482-12-20