title: Response to preoperative chemotherapy predicts survival in patients undergoing hepatectomy for liver metastases from gastric and esophageal cancer.
abstract: BACKGROUND
  The role of hepatectomy for patients with liver metastases from gastric and esophageal cancer (GELM) is not well defined. The present study examined the morbidity, mortality, and long-term survivals after liver resection for GELM.
  
  
  METHODS
  Clinicopathological data of patients who underwent hepatectomy for GELM between 1995 and 2012 at two European high-volume hepatobiliary centers were assessed, and predictors of overall survival (OS) were identified. In addition, the impact of preoperative chemotherapy for GELM on OS was evaluated.
  
  
  RESULTS
  Forty-seven patients underwent hepatectomy for GELM. The primary tumor was located in the stomach, cardia, and distal esophagus in 27, 16, and 4 cases, respectively. Twenty patients received preoperative chemotherapy before hepatectomy. After a median follow-up time of 76 months, 1-, 3-, and 5-year OS rates were 70, 37, and 24%, respectively. Postoperative morbidity and mortality rates were 32 and 4%, respectively. Outcomes were comparable between the two centers. Preoperative chemotherapy for GELM (5-year OS: 45 vs 9%, P = .005) and the lack of posthepatectomy complications (5-year OS: 34 vs 0%, P < .0001) were significantly associated with improved OS in univariate and multivariate analyses. When stratifying OS by radiologic response of GELM to preoperative chemotherapy, patients with progressive disease despite preoperative treatment had significantly worse OS (5-year OS: 0 vs 70%, P = .045).
  
  
  CONCLUSIONS
  For selected patients with GELM, liver resection is safe and should be regarded as a potentially curative approach. A multimodal treatment strategy including systemic therapy may provide better patient selection resulting in prolonged survival in patients with GELM undergoing hepatectomy.
authors.affiliation: Department of General, Visceral and Transplant Surgery, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany, andreas.andreou@charite.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Andreou
authors.forename: Luca
authors.initials: L
authors.lastname: Viganò
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zimmitti
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.forename: Martin
authors.initials: M
authors.lastname: Dreyer
authors.forename: Andreas
authors.initials: A
authors.lastname: Pascher
authors.forename: Marcus
authors.initials: M
authors.lastname: Bahra
authors.forename: Wenzel
authors.initials: W
authors.lastname: Schoening
authors.forename: Volker
authors.initials: V
authors.lastname: Schmitz
authors.forename: Peter C
authors.initials: PC
authors.lastname: Thuss-Patience
authors.forename: Timm
authors.initials: T
authors.lastname: Denecke
authors.forename: Gero
authors.initials: G
authors.lastname: Puhl
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.forename: Sven-Christian
authors.initials: SC
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D015331:Cohort Studies; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult