Major hepatectomy for isolated metastases from gastric adenocarcinoma

Liver metastases from gastric adenocarcinoma denote a poor prognosis. Most gastric metastases will be diffuse, and for these chemotherapy remains the only useful treatment modality. The treatment of isolated liver metastases is still unclear. The Japanese literature has reported good results with surgical resection, but Western series were unable to achieve the same results. We report our results with resection of liver metastases from gastric cancer in nine patients.

A retrospective analysis was undertaken to determine the results of the surgical treatment of hepatic metastases from gastric carcinoma over the last five decades. Only nine patients underwent such treatment. Variables analysed were age, gender, the primary tumour, the type of liver operation performed, the time of occurrence of liver metastasis, the morbidity and mortality and the overall survival. Follow-up was complete.

There were eight patients with gastric carcinoma staged as T3 and one as T4 (UICC-97). All patients had positive lymph nodes. The hepatic procedure performed was a hemihepatectomy in eight patients and a left lateral segmentectomy in one patient. Right hepatectomy was performed in six cases. There were four patients with synchronous liver metastasis: three involved the right liver and the other involved segments II/III. All were treated by one-step surgery. The five metachronous metastases involved the right liver in three patients (accounting for half of the right hepatectomies), while the other two underwent left hepatectomies. There was a high postoperative mortality rate (33%, 3/9), two of the deaths occurring in the first decade of the study (1956, 1966) secondary to hepatic insufficiency and one from sepsis. One patient died suddenly without recurrence after 3 months. The other five died with evidence of disease at between 2 and 11 months.

Despite some anecdotal reports of treatment with chemotherapy, either systemic or intrahepatic, the more consistent results for the treatment of patients with hepatic metastases from gastric adenocarcinoma come from the Japanese literature with the use of radical surgery. Unfortunately, Western series, including our own, do not achieve the same results. At the present time, in view of these results, we are performing less aggressive treatment such as radio-frequency ablation.