title: Gastric cancer and synchronous hepatic metastases: is it possible to recognize candidates to R0 resection?
abstract: OBJECTIVE
  Management of patients with synchronous hepatic metastases as the sole metastatic site at diagnosis of gastric cancer is debated. We studied a cohort of patients admitted to surgical units, investigating prognostic factors of clinical relevance and the results of various therapeutic strategies.
  
  
  METHODS
  Retrospective multicentre chart review. We evaluated how survival from surgery was influenced by patient-related, gastric cancer-related, metastasis-related and treatment-related candidate prognostic factors.
  
  
  RESULTS
  Forty-four patients received palliative surgery without resection, 98 palliative gastrectomy (in 16 cases associated with R+ hepatectomy), whereas 53 patients received both curative gastrectomy and hepatic resection(s) (R0). Adjuvant chemotherapy was administered to 44 patients. Therapeutic approach was selected on the basis of extension of disease, patient's general conditions and surgeon's attitude. Surgical mortality was 4.6 % and morbidity was 17.4 %. Survival was independently influenced by the factor T of the gastric primary (p = 0.036) and by the degree of hepatic involvement (p = 0.010). T > 2 and H3 liver involvement were associated with worse prognosis with cumulative effect (p = 0.002). Therapeutic approach to the metastases (p = 0.009) and adjuvant chemotherapy (p < 0.001) displayed independent impact upon survival, with benefit for those receiving aggressive multimodal treatment. The 1-, 3-, and 5-year survival rates were 50.4, 14.0, and 9.3 %, respectively, for patients submitted to curative surgery, 16, 8.5, and 4.3 % after palliative gastrectomy, and 6.8, 2.3, and 0 % after palliative surgery without resection.
  
  
  CONCLUSIONS
  Our data suggest some clinical criteria that may facilitate selection of candidates to curative surgery, which offers the best survival chances, especially when associated with adjuvant chemotherapy.
authors.affiliation: Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, guido.tiberio@libero.it.
authors.forename: Guido Alberto Massimo
authors.initials: GA
authors.lastname: Tiberio
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Baiocchi
authors.forename: Paolo
authors.initials: P
authors.lastname: Morgagni
authors.forename: Daniele
authors.initials: D
authors.lastname: Marrelli
authors.forename: Alberto
authors.initials: A
authors.lastname: Marchet
authors.forename: Chiara
authors.initials: C
authors.lastname: Cipollari
authors.forename: Luigina
authors.initials: L
authors.lastname: Graziosi
authors.forename: Silvia
authors.initials: S
authors.lastname: Ministrini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vittimberga
authors.forename: Annibale
authors.initials: A
authors.lastname: Donini
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
authors.forename: Franco
authors.initials: F
authors.lastname: Roviello
authors.forename: Arianna
authors.initials: A
authors.lastname: Coniglio
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Manzoni
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D005743:Gastrectomy; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis