Kazumasa Fujitani1, Yukinori Kurokawa2, Atsushi Takeno3, Ryohei Kawabata4, Takeshi Omori5, Hiroshi Imamura6, Motohiro Hirao7, Shunji Endo8, Junji Kawada9, Jeong Ho Moon10, Noboru Kobayashi2, Tsuyoshi Takahashi2, Makoto Yamasaki2, Shuji Takiguchi11, Masaki Mori12, Hidetoshi Eguchi2, Yuichiro Doki2. 1. Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan. fujitani@gh.opho.jp. 2. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan. 3. Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan. 4. Department of Surgery, Osaka Rosai Hospital, Sakai, Japan. 5. Department of Surgery, Osaka Police Hospital, Osaka, Japan. 6. Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan. 7. Department of Surgery, Osaka National Hospital, Osaka, Japan. 8. Department of Surgery, Higashi-Osaka Medical Center, Higashi-Osaka, Japan. 9. Department of Surgery, Kaizuka Municipal Hospital, Kaizuka, Japan. 10. Department of Surgery, Osaka 2nd Police Hospital, Osaka, Japan. 11. Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medicine, Nagoya, Japan. 12. Department of Surgery and Science, Kyushu University Graduate School of Medicine, Fukuoka, Japan.
Abstract
BACKGROUND: The optimal treatment for liver metastasis from gastric cancer (LMGC) remains uncertain. The relevance of surgical resection is controversial. We conducted a prospective multicenter interventional study of surgical resection for LMGC. PATIENTS AND METHODS: Patients with synchronous or metachronous LMGC who were surgically fit were registered. The primary endpoint was 3-year overall survival (OS) of patients who underwent R0 resection. Secondary endpoints were R0 resection rate, operative morbidity and mortality, 3-year recurrence-free survival (RFS) of R0 patients, and OS in all registered patients. RESULTS: Seventy patients were registered from 24 institutions between December 2011 and November 2019 and received preoperative chemotherapy. Three patients were ineligible, and 19 patients discontinued treatment, with disease progression in 12, adverse events in 4, and consent withdrawal in 3 before surgery. Of the 48 patients eventually undergoing surgery, R0 resection of the primary and/or metastatic GC was accomplished in 43 patients, while 1 patient discontinued treatment for positive peritoneal lavage cytology and 4 patients were considered ineligible based on postoperative pathological findings other than GC. The R0 resection rate of all eligible patients was 68.3% [95% confidence interval (CI) 55.3-79.4%, 43/63 patients], while that of all resected patients was 89.6% (95% CI 77.3-96.5%, 43/48 patients). Postoperative complications were identified in 12 out of 43 patients (27.9%), and Clavien-Dindo grade III or higher complications occurred in seven patients (16.3%). No hospital mortality was observed. CONCLUSIONS: R0 resection for LMGC could be performed in approximately two-thirds of all eligible patients, with acceptable surgical morbidity and mortality.
BACKGROUND: The optimal treatment for liver metastasis from gastric cancer (LMGC) remains uncertain. The relevance of surgical resection is controversial. We conducted a prospective multicenter interventional study of surgical resection for LMGC. PATIENTS AND METHODS: Patients with synchronous or metachronous LMGC who were surgically fit were registered. The primary endpoint was 3-year overall survival (OS) of patients who underwent R0 resection. Secondary endpoints were R0 resection rate, operative morbidity and mortality, 3-year recurrence-free survival (RFS) of R0 patients, and OS in all registered patients. RESULTS: Seventy patients were registered from 24 institutions between December 2011 and November 2019 and received preoperative chemotherapy. Three patients were ineligible, and 19 patients discontinued treatment, with disease progression in 12, adverse events in 4, and consent withdrawal in 3 before surgery. Of the 48 patients eventually undergoing surgery, R0 resection of the primary and/or metastatic GC was accomplished in 43 patients, while 1 patient discontinued treatment for positive peritoneal lavage cytology and 4 patients were considered ineligible based on postoperative pathological findings other than GC. The R0 resection rate of all eligible patients was 68.3% [95% confidence interval (CI) 55.3-79.4%, 43/63 patients], while that of all resected patients was 89.6% (95% CI 77.3-96.5%, 43/48 patients). Postoperative complications were identified in 12 out of 43 patients (27.9%), and Clavien-Dindo grade III or higher complications occurred in seven patients (16.3%). No hospital mortality was observed. CONCLUSIONS: R0 resection for LMGC could be performed in approximately two-thirds of all eligible patients, with acceptable surgical morbidity and mortality.
Authors: S-E Al-Batran; J T Hartmann; R Hofheinz; N Homann; V Rethwisch; S Probst; J Stoehlmacher; M R Clemens; R Mahlberg; M Fritz; G Seipelt; M Sievert; C Pauligk; A Atmaca; E Jäger Journal: Ann Oncol Date: 2008-07-31 Impact factor: 32.976
Authors: David Cunningham; Naureen Starling; Sheela Rao; Timothy Iveson; Marianne Nicolson; Fareeda Coxon; Gary Middleton; Francis Daniel; Jacqueline Oates; Andrew Richard Norman Journal: N Engl J Med Date: 2008-01-03 Impact factor: 91.245
Authors: S H Cheon; S Y Rha; H-C Jeung; C-K Im; S H Kim; H R Kim; J B Ahn; J K Roh; S H Noh; H C Chung Journal: Ann Oncol Date: 2008-02-27 Impact factor: 32.976
Authors: Johannes Zacherl; Maximilian Zacherl; Christian Scheuba; Rudolf Steininger; Etienne Wenzl; Ferdinand Mühlbacher; Raimund Jakesz; Friedrich Längle Journal: J Gastrointest Surg Date: 2002 Sep-Oct Impact factor: 3.452