title: Hepatic resection for metastatic tumors from gastric cancer.
abstract: OBJECTIVE
  To assess the surgical results and clinicopathologic features of hepatic metastases from gastric adenocarcinoma to identify patients with a better probability of survival.
  
  
  BACKGROUND
  Many studies have reported the benefit of hepatic resection for metastatic tumors from colorectal cancer. However, indications for a surgical approach for gastric adenocarcinoma involving the liver have not been clearly defined.
  
  
  METHODS
  Ninety (11%) of 807 patients with primary gastric cancer were diagnosed with synchronous (n = 78) or metachronous (n = 12) hepatic metastases. Of these, 19 underwent 20 resections intended to cure the metastatic lesion in the liver. The clinicopathologic features of the hepatic metastases in, and the surgical results for, the 19 patients were analyzed.
  
  
  RESULTS
  The actuarial 1-year, 3-year, and 5-year survival rates after hepatic resection were, respectively, 77%, 34%, and 34%, and three patients survived for more than 5 years after surgery. Solitary and metachronous metastases were significant determinants for a favorable prognosis after hepatic resection. Pathologically, a fibrous pseudocapsule between the tumor and surrounding hepatic parenchyma was found in 13 of the 19 patients (68%). The presence of a peritumoral fibrous pseudocapsule and a well-differentiated histologic type of metastatic nodule were significant prognostic factors. Factors associated with the primary lesion were not significant prognostic determinants in patients who underwent curative resection of the primary cancer.
  
  
  CONCLUSIONS
  Solitary and metachronous metastases from gastric cancer should be treated by a surgical approach and confer a better prognosis. A new prognostic factor, the presence of a pseudocapsule, may be helpful in defining indications for postoperative adjuvant treatment.
authors.affiliation: First Department of Surgery, Kagawa Medical University, Kagawa, Japan. kokano@kms.ac.jp
authors.forename: Keiichi
authors.initials: K
authors.lastname: Okano
authors.forename: Takashi
authors.initials: T
authors.lastname: Maeba
authors.forename: Ken
authors.initials: K
authors.lastname: Ishimura
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Karasawa
authors.forename: Fuminori
authors.initials: F
authors.lastname: Goda
authors.forename: Hisao
authors.initials: H
authors.lastname: Wakabayashi
authors.forename: Hisashi
authors.initials: H
authors.lastname: Usuki
authors.forename: Hajime
authors.initials: H
authors.lastname: Maeta
mesh_terms: D000206:Actuarial Analysis; D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D000368:Aged; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000601:surgery; D011379:Prognosis; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery; D013997:Time Factors