The role of hepatectomy in the management of metastatic gastric adenocarcinoma: A systematic review |
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| Affiliation: | 1. Royal Victoria Hospital, Belfast, Northern Ireland, BT12 6BA, United Kingdom;2. Altnagelvin Area Hospital, Derry, Northern Ireland, BT47 6SB, United Kingdom;3. Liverpool Hepatobiliary Centre, University Hospital Aintree, Liverpool, L9 7AL, United Kingdom;1. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN;2. Indiana University Health, Indianapolis, IN;3. Department of Surgery, Temple University School of Medicine, Philadelphia, PA;1. Service d’Anatomie Pathologique, Cliniques universitaires Saint-Luc, Université catholique de Louvain, 1200 Brussels, Belgium;2. Division of Liver Diseases, Mount Sinai School of Medicine, 10029 New York, USA;3. Department of Pathology and Medical Biology, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands;4. Chirurgie Hépatobiliaire et Pancréatique, CHU de Bordeaux, Maison-du-Haut-Lévèque, 33604 Pessac cedex, France;5. Inserm, UMR-674, Génomique fonctionnelle des tumeurs solides, IUH, Paris, France;6. Université Paris Descartes, Labex Immuno-oncology, Sorbonne Paris Cité, Faculté de Médecine, Paris, France;7. Assistance publique–Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France;8. Inserm U1053, Université Bordeaux Segalen, 33076 Bordeaux cedex, France;9. Department of Pathology, Hôpital Pellegrin, 33076 Bordeaux cedex, France;1. Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Germany;2. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany;1. Department of Surgery, University of Washington, Seattle, WA;2. Department of Biostatistics, University of Washington, Seattle, WA;1. Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden;2. Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, Division of Surgical and Interventional Sciences, University College London, Royal Free Hospital, London, United Kingdom;3. Department of General Surgery, Liver Transplant Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain;4. Department of Surgery and Transplantation, Swiss Hepatopancreaticobiliary and Transplant Center Zürich, University Hospital Zürich, Zürich, Switzerland;5. Department of Surgery, University of Sao Paulo, Sao Paulo, Brazil;6. Division of Transplantation, Hepatobiliary Surgery, University of Rochester, Rochester, NY;7. Department of Surgery, Western University, London, Ontario, Canada;8. Research and Development Unit in Local Healthcare, Linköping University, Linköping, Sweden;1. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky;2. Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island |
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| Abstract: | BackgroundGastric cancer has a high mortality, with many patients presenting with advanced disease. Many patients who undergo curative gastrectomy will subsequently develop metastatic disease. Hepatectomy has an established place in treating metastases from a variety of cancers but its role in gastric cancer is not clear. This review sought to systematically appraise the literature to establish the role of hepatectomy in treating gastric cancer metastases.MethodMedline and EMBASE were searched for all papers publishing data on survival of patients with metastatic gastric adenocarcinoma who underwent hepatectomy.ResultsSeventeen studies with 438 patients were included. There were no randomised controlled trials. Perioperative mortality was 2%, with morbidity between 17 and 60%. Patients with solitary metastases appeared to have better survival. Other favourable survival characteristics included unilobar disease, and metachronous presentation. No advantage was demonstrated with either adjuvant or neoadjuvant chemotherapy.DiscussionFew patients with hepatic metastases from gastric cancer are suitable for hepatectomy, but for those suitable there appears to be survival benefit. Patients with synchronous, multiple or bilobar metastases have worse survival.ConclusionThe evidence supporting the role of hepatectomy in the treatment of hepatic metastases from gastric cancer is weak. However in a selected group there appears to be a survival advantage; patients with solitary metastases had better survival outcomes than those with multiple metastases and metachronous presentation was associated with a better prognosis than synchronous presentation. Hepatectomy should be considered in these patients in the setting of a randomised trial. |
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| Keywords: | Gastric cancer Metastatic gastric cancer Hepatectomy |
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