title: Factors influencing survival after hepatectomy for metastases from gastric cancer.
abstract: OBJECTIVE
  To investigate clinical factors influencing the prognosis of patients submitted to hepatectomy for metastases from gastric cancer and their clinical role.
  
  
  METHODS
  Retrospective multi-center 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
  One hundred and five patients submitted to hepatectomy for metastases from gastric cancer, in the synchronous and metachronous setting of the disease. In 89 cases a R0 resection was achieved, while in 16 a R+ hepatic resection was performed. Adjuvant chemotherapy was administered to 29 patients. Surgical mortality was 1% and morbidity 13.3%. Median disease-free survival was 10 months, median overall survival was 14.6 months. Overall 1, 3, and 5-year survival rates were 58.2%, 20.3%, and 13.1%, respectively. Survival was influenced independently by the factor T of the gastric primary (p < 0.001), by the curativity of surgical procedure (p = 0.001), by the timing of hepatic involvement (p < 0.001) and by adjuvant chemotherapy (p < 0.001). T4 gastric cancer, R+ resection, synchronous metastases, and abstention from adjuvant chemotherapy were associated with a worse prognosis; T4 gastric cancer and R+ resections displayed a cumulative effect (p < 0.001).
  
  
  CONCLUSIONS
  Our data show that R0 resection must be pursued whenever possible. Furthermore, in the synchronous setting, the coexistence of T4 gastric primaries and R+ resections suggests prudence and probably abstention from hepatectomy. Finally, a multimodal treatment associating surgery and chemotherapy offers the best survival results.
authors.affiliation: Surgical Clinic, Department of Clinical and Experimental Sciences. University of Brescia, Italy. Electronic address: guido.tiberio@unibs.it.
authors.forename: G A M
authors.initials: GA
authors.lastname: Tiberio
authors.affiliation: Surgical Clinic, Department of Clinical and Experimental Sciences. University of Brescia, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ministrini
authors.affiliation: Department of General Surgery, Morgagni Hospital, Forlì, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gardini
authors.affiliation: Surgical Oncology, Department of Human Pathology and Oncology, University of Siena, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Marrelli
authors.affiliation: Department of Oncological and Surgical Sciences, University of Padova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Marchet
authors.affiliation: Division of General Surgery, University of Verona, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Cipollari
authors.affiliation: General Surgery, Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Graziosi
authors.affiliation: Division of General and Hepatobiliary Surgery, University of Verona, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Pedrazzani
authors.affiliation: Surgical Clinic, Department of Clinical and Experimental Sciences. University of Brescia, Italy.
authors.forename: G L
authors.initials: GL
authors.lastname: Baiocchi
authors.affiliation: Department of General Surgery, Morgagni Hospital, Forlì, Italy.
authors.forename: G
authors.initials: G
authors.lastname: La Barba
authors.affiliation: Surgical Oncology, Department of Human Pathology and Oncology, University of Siena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Roviello
authors.affiliation: General Surgery, Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Donini
authors.affiliation: Division of General Surgery, University of Verona, Italy.
authors.forename: G
authors.initials: G
authors.lastname: de Manzoni
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate
keywords: Gastric cancer; Hepatectomy; Hepatic metastasis; Prognostic factors