title: Favorable indications for hepatectomy in patients with liver metastasis from gastric cancer.
abstract: BACKGROUND
  The prognosis of patients with liver metastasis from gastric cancer (LMGC) is dismal. The purpose of this study was to review our recent outcomes of hepatectomy for LMGC and to determine the suitable candidates for surgery.
  
  
  METHODS
  The outcomes of 37 patients with LMGC who underwent hepatectomy between 1990 and 2005 were assessed. No extrahepatic distant metastasis and feasibility of macroscopic curative resection were requisite indications for surgery. The prognostic values of clinicopathological factors were assessed by univariate and multivariate analyses.
  
  
  RESULTS
  There was no in-hospital mortality. The median survival time and overall 5-year survival rate after hepatectomy of the patients with LMGC were 31 months and 11%, respectively. Intrahepatic recurrence following hepatectomy was found in 23 patients (62%). Variables independently associated with poor survival were bilobar metastasis (P = 0.002, CI = 1.9-16.3) and a maximum tumor diameter of >or= 4 cm (P = 0.006, CI = 1.4-7.7). The depth of the primary tumor and the timing of metastasis were not associated with survival.
  
  
  CONCLUSIONS
  Surgical resection for LMGC may be indicated in patients with unilobar metastasis and/or tumors less than 4 cm in diameter. Synchronous metastasis is not a contraindication for hepatectomy.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan. yosakamo@ncc.go.jp
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sano
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
authors.forename: Minoru
authors.initials: M
authors.lastname: Esaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Saka
authors.forename: Takeo
authors.initials: T
authors.lastname: Fukagawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Katai
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Sasako
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D005743:Gastrectomy; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome