title: Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England.
abstract: BACKGROUND
  The objectives of this national study were to examine the short-term safety and long-term survival benefit associated with surgical resection of hepatic metastases from gastric cancer.
  
  
  METHODS
  Patients from the Hospital Episode Statistics database were classified by disease and treatment approach. Gastric cancer: 1. Without liver metastases treated by gastrectomy (GG). 2. With liver metastases treated by gastrectomy and hepatectomy (GGH). 3. With liver metastases treated by gastrectomy without hepatectomy (GGNH). 4. With liver metastases treated with no surgery (GNS). Propensity score matching and multivariable analyses were used to compensate for differences in some baseline characteristics.
  
  
  RESULTS
  During the study period, 87,482 were patients diagnosed with gastric cancer, of whom 13,841 underwent partial or total gastrectomy. Of those who underwent gastrectomy, 336 had a diagnosis of liver metastases and 78 of these had a hepatectomy. Propensity-matched analysis showed no significant differences in 30- or 90-day mortality between the GGH and GG groups. The GGH group had significantly improved 1-year mortality (35.9 % vs. 50.0 %, p = 0.049) and 5-year mortality (61.5 % vs. 75.7 %, p = 0.031) compared to the GGNH group, and compared to the GNS group, the GCH group had 1-year mortality (35.9 % vs. 84.6 %, p < 0.001) and 5-year mortality (61.5 % vs. 90.8 %, p < 0.001).
  
  
  CONCLUSIONS
  This study showed that hepatectomy for synchronous gastric cancer hepatic metastases may carry survival benefits in selected patients. The data presented should not be a rationale to change current clinical practice but rather a stimulus to prospectively study the role of surgery in a selected group of patients who are currently treated with palliative chemotherapy.
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, South Wharf Road, London, W21NY, UK. s.markar@imperial.ac.uk.
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, South Wharf Road, London, W21NY, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Mackenzie
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, South Wharf Road, London, W21NY, UK.|Department of General Surgery, Cairo University, Giza, Egypt.
authors.forename: Sameh
authors.initials: S
authors.lastname: Mikhail
authors.affiliation: Department of Surgery, University College London Hospital, London, UK.
authors.forename: Muntzer
authors.initials: M
authors.lastname: Mughal
authors.affiliation: The Oesophago-Gastric Unit, Department of Surgery, Royal Surrey County Hospital, Guildford, UK.
authors.forename: Shaun R
authors.initials: SR
authors.lastname: Preston
authors.affiliation: Oxford Oesophagogastric Center, Churchill Hospital, Oxford, UK.
authors.forename: Nick D
authors.initials: ND
authors.lastname: Maynard
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, South Wharf Road, London, W21NY, UK.|St. Mark's Hospital and Academic Institute, Harrow, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Faiz
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, South Wharf Road, London, W21NY, UK.
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
mesh_terms: D000368:Aged; D004739:England; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000401:mortality*; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors
keywords: Gastric cancer; Hepatectomy; Hepatic metastases; Survival