title: Resection of liver metastasis from gastric adenocarcinoma.
abstract: OBJECTIVE
  To determine the factors influencing the prognosis of patients undergoing resection of liver metastases from gastric adenocarcinoma.
  
  
  METHODS
  Over a 10-year period, at Kiryu Kousei General Hospital, 12 patients underwent potentially curative hepatectomy for metastatic adenocarcinoma of gastric origin. Two patients were excluded from this study, one because of postoperative death and one due to insufficient follow-up. We retrospectively examined the following factors: including TNM classification of the primary tumor, disease-free interval between gastric and hepatic resection, number and maximum diameter of the metastases, histological differentiation of the metastases, and the presence of lymphocyte aggregation enclosing the metastatic lesions. Survival rates were estimated by the Kaplan-Meier method and the weighting of each factor was compared by the log-rank test.
  
  
  RESULTS
  The overall 5-year survival rate of the 10 patients was 10%. The median survival time after hepatectomy was 16.3 months, ranging from 3.1 to 245.7 months. Eight patients died of recurrent cancer and 1 died of unrelated septic shock with no evidence of cancer recurrence. Only one patient was alive without recurrence at the time of maximum follow-up. A significant survival advantage was noted in patients with disease-free interval > or = 1 year, and those with metastatic tumors < 5 cm in maximum diameter and/or enclosed by the aggregated lymphocytes, when compared with patients with disease-free interval < 1 year and those with metastatic tumors > or = 5 cm and/or directly infiltrated hepatic parenchyma.
  
  
  CONCLUSIONS
  It was suggested that hepatectomy should be attempted in patients where the disease-free interval was > or = 1 year and with metastatic nodules < 5 cm. Lymphocyte aggregation around the metastatic tumor is a good prognostic sign for long-term survival.
authors.affiliation: Department of Surgery, Kiryu Kousei General Hospital, Kiryu, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Fujii
authors.forename: S
authors.initials: S
authors.lastname: Fujioka
authors.forename: K
authors.initials: K
authors.lastname: Kato
authors.forename: Y
authors.initials: Y
authors.lastname: Machiki
authors.forename: Y
authors.initials: Y
authors.lastname: Kutsuna
authors.forename: A
authors.initials: A
authors.lastname: Ishikawa
authors.forename: J
authors.initials: J
authors.lastname: Takamizawa
authors.forename: K
authors.initials: K
authors.lastname: Ko
authors.forename: K
authors.initials: K
authors.lastname: Yoshida
authors.forename: Y
authors.initials: Y
authors.lastname: Nimura
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology*