Our experience in the management of patients at metastatic stage at first diagnosis of Gastric Cancer (original) (raw)

Surgical Treatment of Liver Metastases from Gastric Cancer

Surgical Science, 2013

Background: Hepatectomy for gastric metastases remains controversial. We aimed at assessing the surgical results, clinicopathological features of gastric cancer liver metastases (GCLM) and prognostic factors. Methods: The outcome of 28 consecutive patients with synchronous (n = 24) or metachronous (n = 4) GCLM was retrospectively analyzed. Curatively, initial hepatectomies such as segmentectomy and hemihepatectomy or non-anatomical limited liver resection less extensive than segmentectomy followed complete primary gastric cancer (GC) resections. Results: Median survival time was 16 months (range, 5-66 months). The actuarial overall 12-, 36-, and 60-month survival rates after hepatectomy were 67.8% (n = 19), 39.2% (n = 11), and 28.5% (n = 8), respectively. In multivariate analysis, absent GC serosal invasion-hazard ratio (HR) 1; 95% confidence interval (CI) 1.2-9.9; P = 0.020; solitary LM-HR 1; 95% CI 1.6-16.0; P = 0.005, and curative liver resection with negative resection margin (R0)-HR 1, 95% CI 2.2-18.0; P = 0.001 were independent prognostic factors. Conclusions: Surgery of GCLM is a good indication in well-selected patients with an absent serosal invasion of primary tumour, single GCLM and attainment of R0 liver resection. For most GCLM patients, however, there are no other therapeutic modalities. Thus systemic chemotherapy remains the best hope for a longer patient's survival and an improved individual quality of life.

Surgery for Liver Metastases From Gastric Cancer

Medicine, 2015

The role of surgical therapy in patients with liver metastases from gastric cancer is still controversial. In this study, we investigated the results obtained with local treatment of hepatic metastases in patients with gastric cancer, by performing a systematic literature review and meta-analysis. We performed a systematic review and meta-analysis of observational studies published between 1990 and 2014. These works included multiple studies that evaluated the different survival rate among patients who underwent local treatment, such as hepatectomy or radiofrequency ablation, for hepatic metastases derived from primary gastric cancer. The collected studies were evaluated for heterogeneity, publication bias, and quality, and a pooled hazard ratio (HR) was calculated with a confidence interval estimated at 95% (95% CI). After conducting a thorough research among all published works, 2337 studies were found and after the review process 11 observational studies were included in the analysis. The total amount of patients considered in the survival analysis was 1010. An accurate analysis of all included studies reported a significantly higher survival rate in the group of patients who underwent the most aggressive local treatment for hepatic metastases (HR 0.54, 95% CI 0.46-0.95) as opposed to patients who underwent only palliation or systemic treatment. Furthermore, palliative local treatment of hepatic metastases had a higher survival rate if compared to surgical (without liver surgery) and systemic palliation (HR 0.50, 95% CI 0.26-0.96). Considering the only 3 studies where data from multivariate analyses was available, we found a higher survival rate in the local treatment groups, but the difference was not significant (HR 0.50, 95% CI 0.22-1.15). Curative and also palliative surgery of liver metastases from gastric cancer may improve patients' survival. However, further trials are needed in order to better understand the role of surgery in this group of patients.

The significance of gastrectomy in advanced gastric cancer patients with hepatic metastasis

Ain Shams Journal of Surgery, 2014

This study was designed to investigate the role of palliative gastrectomy in advanced gastric adenocarcinoma patients having hepatic metastasis without extra-abdominal disease at diagnosis. Patients and methods: This study was performed in General Surgery Department, Tanta University Hospitals, Egypt on 29 patients with advanced gastric cancer having hepatic metastasis. Patients were selected with histopathologically proven gastric adenocarcinoma; presence of hepatic metastasis at the time of diagnosis; absence of extra-abdominal disease and having a performance status of 2 or less on the Eastern Cooperative Oncology Group (ECOG) scale. None had received prior chemotherapy or radiation therapy. Patients were categorized into the two groups; Group I, 8 males and 3 females underwent gastrectomy with subsequent chemotherapy. Eighteen patients in group II, 11 males and 7 females received chemotherapy alone without gastrectomy. All patients were treated with systemic 5-fluorouracil based regimens. Results: The mean follow-up time was 258±122 days. The mean survival of GI and GII patients were 397±59.7 and 173±46.8 days (p > 0.0001). The mean metastatic progressionfree survival was 329±54.7 and 141±49.4 days (p > 0.001). In 11 (38%) of 29 patients the primary tumor was removed (total gastrectomy in 7 and distal gastrectomy 4 patients). No patient underwent liver resection. Wound infection developed in one of the patients of the resection group. He were conservatively treated. One of the patients was reoperated for minor leakage from the anastomosis leading to intraabdominal collection. The mean hospital stay of the first admission for GI and GII patients was 13.9 ±6.41 and 4.28±1.41 days respectively (p>0.0001). The Hospitalization index was not different between the two groups. The Ingestion index was significantly higher in GI than in GII. Gastrectomy increased the survival of the patients regardless to their number and localization of hepatic metastasis. Related risk factors based on the univariate analysis were serum tumor marker levels (p 0.036), number of hepatic metastasis (p 0.0045), resection of primary tumor (p >0.0001) and the absence of extra hepatic spread (p 0.027). Conclusion: Despite stage IV patients have poor prognosis, removal of the intact primary tumor for gastric cancer with synchronous hepatic metastasis at diagnosis is associated with improvement in overall survival and metastatic progression-free survival.

Management of liver metastases from gastric carcinoma: where is the evidence?

La Tunisie médicale, 2013

Liver metastases of gastric carcinoma are often the synonym of advanced neoplastic disease which has long justified the indication of palliative chemotherapy. However, inspired by the good results of the management of liver metastases of colorectal cancers,several surgeons have focused on the treatment of liver metastases of gastric carcinoma. The different therapeutic modalities used are surgery, radiofrequency ablation, hepatic arterial infusion and palliative gastrectomy. To provide evidence based answer to the following questions regarding liver metastases from gastric carcinoma: 1. What is the indication of surgery? 2. Does radiofrequency ablation useful? 3. What is the contribution of the hepatic arterial infusion? 4. Is there any benefit to palliative gastrectomy? A literature search on PubMed database over the period from January 1990 to December 2011 was conducted using as key words "gastric cancer" and "liver metastases". Surgery of a single liver metas...

Outcome of Operative Therapy of Hepatic Metastatic Stomach Carcinoma: A Retrospective Analysis

World Journal of Surgery, 2012

Background In general, hepatic metastasis from stomach carcinoma has an unfavorable prognosis. In addition, there are often further metastases in other organs, such as peritoneal carcinomatosis. The major aim of the present study was to investigate a potential curative surgical approach in these patients. Material and methods Thirty-one patients with hepatic metastases from stomach cancer were treated in the University Clinic Erlangen-Nürnberg. The data were collected retrospectively from 1972 to 1977 and prospectively since 1978 at the Erlangen Cancer Registry. The time frame of this retrospective analysis from patients who had surgical resection of hepatic metatases from gastric cancer was from 1972 to 2008. The median age of the patients was 65 years, and the ratio of men to women was 2:1. Results Atypical or anatomical resections of segments were possible in 21 cases. Larger operations, such as hemihepatectomy (right/left), were performed in 10 patients. The postoperative complication rate was 29%, and the hospital mortality was 6%. The five-year survival rate was 13%; R0 resection was achieved in 23 patients. We also found a significant difference in the 5-year survival rate between synchronous and metachronous metastases (0 vs. 29%; p \ 0.001) and R0 resected patients (p = 0.002). Patients with solitary metastases had a significantly better median survival than patients with multiple metastases (21 vs. 4 months; p \ 0.005.) Conclusions The overall survival in our study was 13%; therefore gastric cancer with liver metastases is not in every case a palliative situation. It seems that patients with liver metastases benefit from resection, especially if the metastases are metachronous (p \ 0.001) and solitary, provided that a curative R0 resection has been achieved. An interdisciplinary approach with neoadjuvant chemotherapy appears useful. Additional controlled studies should be conducted. C. W. Schildberg and R. Croner equally contributed to this article.

The value of resection of primary tumor in gastric cancer patients with liver metastasis

Indian Journal of Surgery, 2010

Purpose Surgery for gastric cancer with synchronous liver metastasis is applied for palliation. The aim was to determine whether surgical removal of the primary tumor provides a better survival and disease progression Methods Sixty-two patients are classified according to the primary tumor were removed or not. Patients and tumor characteristics, removal of the primary tumor are examined as the factors that were affecting overall survival and metastatic progression-free survival. Results The mean follow-up time was 243±23 days. The mean survival of the resection and nonresection groups were 422±50 and 170±16 days (p = 0.0001), respectively. After adjustment for other covariates, resection was associated with a trend toward improvement in overall survival (p = 0.003; relative risk RR: 0.34; 95% confidence interval (CI): 0.17-0.66) and improvement in metastatic progression-free survival (p = 0.07, RR = 0.51; 95% CI: 0.25-1.07). Conclusions Excision of the primary tumor has an effect on metastatic progression-free survival and overall survival.

Metastatic cancer to the stomach

Gastric Cancer, 2006

Goiás Anticancer Association, GO, Brazil necropsies [1], and surgical specimens [7], or a combination of these three methods [2,3,8]. The most frequently described primary sites are the lung, breast, melanoma, and the esophagus, among other less prevalent areas [1-4]. The endoscopic aspect of metastatic lesions varies considerably and, although a consensus has not yet been reached, several classifications have been put forth [2,3,5,6]. The prognosis is almost invariably poor, because this condition is a disseminated disease [8,9]. The aim of the present study was to describe a series of cases of metastasis to the stomach, their primary sites, clinical and endoscopic features, treatment, and results. Patients and methods From December 1999 to January 2004, 771 patients with gastric neoplasms, including adenocarcinomas, lymphomas, and sarcomas, among others, were admitted to the Araújo Jorge Hospital. This study is based on a series of 20 cases of gastric metastasis diagnosed during that period, at the Department of Digestive Endoscopy of the Araújo Jorge Hospital. Patients showing direct invasion by an adjacent organ and those with systemic lymphoma were excluded from this study. Esophagogastroduodenoscopy (EGD) was used for diagnostic purposes and all lesions were confirmed by histology, following an endoscopic biopsy. The analysis included epidemiological aspects, symptomatology, indication for endoscopic investigation, macroscopic presentation, and period of time between the diagnosis of the primary tumor and detection of the gastric metastasis, as well as the treatment approach for these metastases. The study included six patients whose stomachs had been raised to the mediastinal level as a result of a transhiatal esophagectomy. In these patients, the gastric Abstract Background. Metastases in the stomach are rare. The increased use of esophagogastroduodenoscopy (EGD), associated with better treatment results for malignancies, requires them to be acknowledged. The aim of this study was to describe a series of cases of metastasis to the stomach, their primary sites, clinical and endoscopic features, treatment, and results. Methods. Twenty cases were diagnosed between December 1999 and January 2004. Their analysis included symptomatology, macroscopic presentation, time from diagnosis of the primary tumor to the detection of the gastric metastasis, treatment approach, and survival. Results. The primary sites were the esophagus, skin, lung, cervix, breast, sigmoid colon, and testis. The symptom most frequently requiring EGD was upper gastrointestinal bleeding. Ten patients showed concomitant metastases to other organs. The mean time between diagnosis of the primary tumor and diagnosis of gastric metastasis was 16 months (range, 0 to 56 months). Only seven patients were given some form of treatment after diagnosis of the gastric metastasis. The median survival was 4.75 months. Overall survival during the first year was 20% and survival was nil at 2 years. Conclusions. Gastric metastasis marks advanced disease and the prognosis is poor. New advances in diagnosis and treatment are required for better results.