Treatment And Systematic Analysis Of Liver Metastasis From Gastric Cancer

Objective:To systematically evaluate the postoperative long-term survival rate of patients with gastric cancer with hepatic metastasis treated by radical resection and the prognostic factors affecting the resection.Methods:Two reviewers independently searched databases including Pub-Med,Medline,Web of science5.3v,Springer-link,CBM,Wan Fang Data and CNKI.The retrieval time was from the construction of the database to December 31,2017.The combination of subject words and free words is adopted.The English retrieval formula is:[(gastric cancer)And(liver metastasis)OR(hepatic metastasis)And(gastrectomy)And(hepatectomy)].Chinese search terms included:gastric cancer,liver metastasis,liver resection.Two reviewers independently screened the literature according to inclusion and exclusion criteria,extracted data and evaluated the risk of bias,and then used Stata12.0 software for Meta analysis.Fixed effect model was used for Meta analysis when there was no or low heterogeneity between included studies.If significant heterogeneity exists,random effect model is adopted for analysis.The heterogeneity between studies was analyzed by Q test,and the heterogeneity was expressed by I~2 value.Low heterogeneity was defined as I~2<25%,moderate heterogeneity was defined as 25%<I~2<75%,and high heterogeneity was defined as I~2>75.P<0.05 was considered statistically significant.The counting data were expressed as Relative risk(RR)and 95%confidence interval(95%CI).Results:In the 18 studies,the combined productivity of radical gastrectomy combined with liver metastasis resection was 73.0%,36.0%and 23.0%respectively 1,3 and 5 years.The median incidence of complications after 30 days of resection for hepatic metastasis with gastric cancer was 23%(0%-40%),and the median mortality after 30 days was 0%.The mean survival time after radical gastrectomy combined with liver metastasis resection was 27 months(11-48).In the 9 cohort studies,the meta-analysis results of random effect model showed that the merger RR value of single vs.multiple was 0.36,95%CI(0.28-0.47),P<0.001.The effect of single versus multiple incidence on long-term survival was statistically significant.In the 6 cohort studies with 5cm and<5cm,the random effect model meta-analysis results showed that the RR value of<5cm vs.5cm combined was 0.22,95%CI(0.116-0.314)P<0.001.The effect of 5cm and<5cm on the long-term survival rate of patients with gastric cancer with liver metastasis after radical gastrectomy combined with liver metastasis resection was statistically significant.Conclusion:The available evidence shown that patients with gastric cancer with liver metastasis can benefit from radical resection combined with liver metastasis resection.In particular,single liver metastasis<5cm had the best prognosis after radical gastrectomy combined with hepatectomy.Due to the limitation of the number and quality of included studies,the above conclusions may have statistical bias,which needs to be verified by more high-quality prospective clinical studies in the future.