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Influence of Surgical Resection of Hepatic Metastases From Gastric Adenocarcinoma on Long-term Survival: Systematic Review and Pooled Analysis

Markar, Sheraz R. MRCS, MSc, MA; Mikhail, Sameh FRCS; Malietzis, George MRCS; Athanasiou, Thanos PhD, FRCS; Mariette, Christophe PhD, MD; Sasako, Mitsuru PhD, MD; Hanna, George B. PhD, FRCS

doi: 10.1097/SLA.0000000000001542

Objectives: The objectives of this systematic review and pooled analysis were to examine long-term survival, morbidity, and mortality following surgical resection of gastric cancer hepatic metastases and to identify prognostic factors that improve survival.

Background: Patients with hepatic metastases from gastric cancer are traditionally treated with palliative chemotherapy.

Methods: A systematic literature search was undertaken (1990 to 2015). Publications were included if they studied more than 10 patients undergoing hepatectomy for hepatic metastasis from gastric adenocarcinoma in the absence of peritoneal disease or other distant organ involvement. The primary outcome was the hazard ratio (HR) for overall survival. The influence of liver metastasis related factors; multiple vs single and metachronous vs synchronous upon survival was also assessed.

Results: The median number of resections for the 39 studies included was 21 (range 10 to 64). Procedures were associated with a median 30-day morbidity of 24% (0% to 47%) and mortality of 0% (0% to 30%). The median 1-year, 3-year, and 5-year survival were 68%, 31%, and 27%, respectively. Survival was improved in Far Eastern compared with Western studies; 1-year (73% vs 59%), 3-year (34% vs 24.5%), and 5-year (27.3% vs 16.5%). Surgical resection of hepatic metastases was associated with a significantly improved overall survival (HR = 0.50; P < 0.001). Meta-analysis confirmed the additional survival benefit of solitary compared with multiple hepatic metastases (odds ratio = 0.31; P = 0.011).

Conclusions: The observed improved survival rates following the resection of hepatic metastasis from gastric adenocarcinoma in selected patients merit a prospective study to formally address the survival benefits and the influence on quality of life of such approach.

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*Department of Surgery & Cancer, Imperial College London, London, UK

Department of General Surgery, Cairo University, Cairo, Egypt

Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France

§Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.

Reprints: Professor George B. Hanna, PhD, FRCS, Division of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, South Wharf Road, London W2 1NY, UK. E-mail:

The authors declared no conflict of interest. Sheraz R. Markar is supported by the National Institute for Health Research (NIHR).

Both Markar and Mikhail should be considered as cofirst authors.

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