Outcome after Simultaneous Resection of Gastric Primary Tumour and Synchronous Liver Metastases: Survival Analysis of a Single-center Experience in China

Background: The optimal surgical strategy for the treatment of synchronous resectable gastric cancer livermetastases remains controversial. The aims of this study were to analyze the outcome and overall survival ofpatients presenting with gastric cancer and liver metastases treated by simultaneous resection. Materials and
Methods: Between January 1990 and June 2009, 35 patients diagnosed with synchronous hepatic metastasesfrom gastric carcinoma received simultaneous resection of both primary gastric cancer and synchronous hepaticmetastases. The clinicopathologic features and the surgical results of the 35 patients were retrospectively analyzed.
Results: The 5-year overall survival rate after surgery was 14.3%. Five patients survived for more than 5 yearsafter surgery. No mortality has occurred within 30 days after resection, although two patients (5.7%) developedcomplications during the peri-operative course. Univariate analysis revealed that patients with the presenceof lymphovascular invasion of the primary tumor, bilateral liver metastasis and multiple liver metastasessuffered poor survival. Lymphovascular invasion by the primary lesion and multiple liver metastases weresignificant prognostic factors that influenced survival in the multivariate analysis (p=0.02, p=0.001, respectively).
Conclusions: The presence of lymphovascular invasion of the primary tumor and multiple liver metastases aresignificant prognostic determinants of survival. Gastric cancer patients without lymphovascular invasion andwith a solitary synchronous liver metastasis may be good candidates for hepatic resection. Simultaneous resectionof both primary gastric cancer and synchronous hepatic metastases may effectively prolong survival in strictlyselected patients.