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Background
The efficacy of repeat hepatectomy for recurrent colorectal liver metastases has been widely accepted as a treatment of potential cure. However, indication for hepatectomy in cases of gastric cancer liver metastasis (GLM) remains unclear. Moreover, no benefits have been reported of repeat hepatectomy for intrahepatic recurrence of GLM. The aim of this study is to clarify the survival benefit of hepatectomy for primary and recurrent GLM.
Aim
The objective of this retrospective study is to clarify the indications for and benefit of primary and repeat hepatectomy for GLM.
Methods
Seventy-three patients underwent hepatectomies for GLM with curative intent from January 1993 to January 2011. Curative surgery was performed in 64 patients and repeat hepatectomy was done in 14 of 35 patients with intrahepatic recurrence; in total, 78 liver resections were performed. Clinicopathological factors were evaluated by univariate and multivariate analysis among patients who received curative resection for those affecting survival.
Results
The cancer-specific 1-, 3-, and 5-year survival rates after curative hepatectomy (n = 64) for GLM were 87, 50, and 37%, respectively, with a median survival of 34 months. By multivariate analysis, serosal invasion of the primary gastric cancer and larger tumor (> 5 cm in diameter) were found to be independent indicators of poor prognosis. Forty-three patients developed postoperative recurrence (67%) after the curative resection for GLM. Intrahepatic recurrence occurred in 37 patients, corresponding to 86% of all patients with recurrence. A repeat hepatectomy for intrahepatic recurrence was performed in 14 patients (40%) based on the same indication as initial hepatectomy for GLM. The actuarial 1-, 3-, and 5-year cancer-specific survival rates after second hepatectomy were 71, 47, and 47%, respectively, with a median survival of 30 months. Three patients have survived more than 5 years after the repeat hepatectomy.
Conclusions
GLM patients with tumors < 5 cm in diameter and without serosal invasion of the primary gastric cancer are the best candidate for hepatectomy. Repeat hepatectomy for recurrent GLM offers a chance of cure as that after the primary hepatectomy.