[An assessment of liver metastasis resection in gastric cancer]

We assessed cases of gastric cancer in which liver metastases had been resected in our hospital. Liver resection was performed in 359 cases of metastatic cancer beginning in April 2003 when we initiated aggressive liver resection in conjunction with standard therapy. Of the 359 cases, 137 included metastatic liver cancer. The most common primary lesion was colorectal cancer, accounting for 101 cases, followed by gastric cancer with 21 cases. Here, we report on 14 cases of gastric cancer following exclusion of a single case of gastric endocrine tumor. The mean overall recurrence-free survival time after the initial liver resection was 8 months. However, mean survival time was prolonged to 45 months by subsequent chemotherapy and repeat hepatectomy. The 3-year survival rate was 64.2%, and the 5-year survival rate was 34.4%. Multivariate analysis identified total gastrectomy and multiple lesions as significant unfavorable prognostic factors. At our hospital, we consider a primary lesion that has been curatively resected, the absence of distant metastasis, and all liver metastases capable of being safely resected to be the indications for surgery. We have performed standard surgery and D2 lymph node dissection to treat primary gastric cancer lesions and have not observed any local lymph node recurrences. However, recurrence in the remnant liver occurred in more than 70% of the cases. We conclude that performing aggressive resection and postoperative chemotherapy according to the regimen for unresectable gastric cancer contributes to prolonging the survival time.