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Hepatectomy for Liver Metastases From Gastric and Esophageal Cancer: Tumor Biology and Surgical Results Define Outcome
Andreas Andreou*1, Luca Viganò2, Giuseppe Zimmitti2, Martin Dreyer1, Jean-Nicolas Vauthey3, Peter Neuhaus1, Daniel Seehofer1, Lorenzo Capussotti2, Sven-Christian Schmidt1
1Department of General, Visceral and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany; 2Department of HPB and Digestive Surgery, Ospedale Mauriziano "Umberto I", Turin, Italy; 3Surgical Oncology, The UNiversity of texas MDAnderson Cancer Center, Houston, TX
Background: The role of hepatectomy for patients with liver metastases from gastric and esophageal cancer (GELM) is not well defined. The present study examined the morbidity, mortality and long-term survival after liver resection for GELM.
Patients and Methods: Clinicopathological data of patients who underwent hepatectomy for GELM between 1987 and 2012 at two European high-volume hepatobiliary centers were assessed and predictors of overall survival were identified.
Results: Fourty-six patients underwent liver resection for GELM. The primary tumor was located in the stomach and in distal esophagus in 40 and 6 cases, respectively. GELM were synchronous to primary tumor in 33 patients and multiple in 18 patients. In 13 cases, major hepatectomy (resection ≥ 3 liver segments) was performed. Thirty-day postoperative morbidity and mortality rates were 33% and 2%, respectively. After a median follow-up time of 76 months (range 1-135), 1, 3 and 5 year overall survival rates were 70%, 40% and 27%, respectively. Outcomes were comparable between the two centers. At univariate analysis, primary tumor invasion of other organs (T4) (P = 0.004), poorly differentiated carcinoma (P = 0.006), positive lymph node metastases, (P = 0.006), the need for blood transfusions at hepatectomy (P = 0.02), major hepatectomy (P = 0.017) and major posthepatectomy complications (P = 0.001) were associated with worse overall survival after liver resection. Independent risk factors for shorter overall survival identified in multivariate analysis included poorly differentiated carcinoma (hazard ratio [HR] = 3.1, 95% confidence interval [CI] = 1.17-8.15, P = 0.022), major hepatectomy (HR = 3.0, 95% CI = 1.22-7.39, P = 0.017) and major posthepatectomy complications (HR = 4.1, 95% CI = 1.31-12.57, P = 0.015).
Conclusions: liver resection should be considered in selected patients with GELM. Patients with poor differentiated tumor and those who require major hepatectomy because of more advanced disease derive the least benefit from this approach.
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