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.
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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.
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