| ObjectivesLiver is one of the common organs involved in gastric cancer and the incidence of synchronous hepatic metastasis was reported to be 2%-9%.Moreover,gastric cancer with synchronous hepatic metastasis(GCHM)often associated with lymph node metastasis,peritoneal dissemination,intrahepatic metastasis and direct invasion to adjacent organs,which indicate poor prognosis.Some methods like surgery,chemotherapy,and interventional therapy have been applied,but no consensus is reached so far.As a potentially curative approach,surgery has been performed in some medical centers.Compared with liver metastases from colorectal cancer with 5-year cumulative survival rate of more than 50%and 10-year cumulative survival rate ranged from 17%-25%,its indications,contraindications,short-and long-term efficacy need to be further investigated.We carried out a retrospective study of preoperative,intraoperative and postoperative data and thus to clarify the indications and efficacy after simultaneous surgical treatment in patients with GCHM.MethodsA total of 21 GCHM patients who underwent D2 gastrectomy with R0 hepatic resection(11 cases)or non-RO hepatic resection(10 cases)from March 2004 to April 2016 were analyzed retrospectively.The clinicopathological characteristics and survival were compared between the two groups.Overall survival time was calculated from the date of operation to the date of death due to the disease.The censored value was the time that from the beginning of follow-up to the end of observation caused by factors unrelated to disease like loss to follow-up,withdrawal,or still alive at the last follow-up visit(2nd June,2016).Software of SPSS 21.0 used for statistical analysis.Quantitative data:x±s was denoted and t test was performed if they are normal distribution;M(min-max)was denoted and Mann-Whitney U test was performed if not.Qualitative data:x 2 test(including Fisher 's exact test)or rank test were performed.Survival curves were calculated by the Kaplan-Meier method and then were compared by log-rank.The multivariate regression analysis of factors related to outcome was performed using the Cox proportional hazards model.A P value less than 0.05 was considered to be statistically significant.ResultsIntraoperative data showed that there was no significant statistical difference between R0 hepatic resection group and non-RO hepatic resection group.Regarding the postoperative data,complications occured in a patient(lymphatic fistula)in R0 hepatic resection group and two patients(one with incisional infection and the other with anastomotic leakage)in non-RO hepatic resection group.No postoperative deaths.Moreover,cumulative survival rate was higher in RO hepatic resection group compared with non-RO hepatic resection group:1-year(54.5%vs.48.0%),2-year(27.3%vs.0%),and 3-year(27.3%vs.0%)(P=0.044).The median survival time in R0 hepatic resection group and non-RO hepatic resection group was 16.2 and 5.9 months(P=0.008).Univariate analysis revealed that Bormann's classification(P=0.010)and state of regional lymph node(P=0.004)were significant predictive factors regarding cumulative survival rate.However,there was no significant prognostic factor(P =0.031)in multivariate analysis might partly owing to interaction among them.Conclusions1.The synchronous hepatic metastasis from gastric cancer is not a contraindication to surgery.It is feasible to perform multidisciplinary treatments based on R0 hepatic resection combined with D2 gastrectomy in selected GCHM patients;2.R0 resection could prolong survival time obviously when compared with non-RO resection without increasing surgical time and morbidity in GCHM patients who are suitable for surgical treatment;3.It is warranted to perform multicenter and large sample prospective study to further confirm an independent prognostic factor. |
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