Do liver metastases from gastric cancer contraindicate aggressive surgical resection? A 14-year single-center experience

Table 1 Indication and contraindication for liver resection for liver metastases originated from gastric cancer.

Indicated	Contraindicated
Radical resection of the primary GC	Tumor number of > 5
No tumor in the remnant liver (curability of LR)	Peritoneal dissemination (incurability of LR)
Remnant liver volume of > 40%	Extrahepatic unresectable site (incurability of LR)
Tumor number of ≤ 5
Any tumor size
No unresectable site (curability of LR)
Regardless of unilobular or bilobular LMGC
Regardless of cytology (CY0 or CY1)
Regardless of synchronous or metachronous LMGC

GC: Gastric cancer; LR: Liver resection; LMGC: Liver metastases originated from gastric cancer.

Table 2 Postoperative recurrence after the initial liver resection and additional surgery

Postoperative recurrence after the initial LR and additional surgery	n
The target sites at the first recurrences after the initial LR (n = 21)
Liver	8
LNs	5
Liver and LNs	3
Lung	2
Liver and lung	2
Liver, LNs and peritoneum	1
Peritoneum	1
Additional surgeries for postoperative recurrences after the initial LR (n = 9)
LR	3
LN dissection	2
Lung resection	2
LR and LN dissection	1
LR and lung resection	1

LR: Liver resection; LN: Lymph node.

Table 3 Important factor for prognostic outcome after the initial liver resection

	Factor	P value
Univariate analyses
Number of LMGC	Actual number	0.7670
	Multiple vs solitary	0.8215
Timing of LMGC	Metachronous vs synchronous	0.3282
Occupation of LMGC	Bilobular vs unilobular	0.8605
The greatest dimension	Actual dimension (mm)	0.6264
	Size of > 50 mm vs size of ≤ 50 mm	0.2520
Serosal invasion (pathological T factor)	PT4 vs pT1-3	0.0249
Curability of LR	Yes or no	0.9999
Lymphatic invasion (pathological ly factor)	Yes or no	0.8004
Vessel invasion (athological v factor)	Yes or no	0.9999
Pathological differentiation	Tub vs others	0.8004
Pathological LN metastases	Yes or no	0.6171
Chemotherapy	Yes or no	0.4017
Multivariate analyses
Serosal invasion (pathological T factor)	PT4 vs pT1-3	0.0052

LMGC: Liver metastases originated from gastric cancer; LR: Liver resection; LN: Lymph node.

Table 4 Univariate analyses for postoperative recurrence after the initial liver resection

	Factor	P value
Number of LMGC	Actual number	0.7860
	Multiple vs solitary	0.9360
Timing of LMGC	Metachronous vs synchronous	0.0906
Occupation of LMGC	Bilobular vs unilobular	0.5719
The greatest dimension	Actual dimension (mm)	0.7343
	Size of > 50 mm vs size of ≤ 50 mm	0.5719
Serosal invasion (pathological T factor)	PT4 vs pT1-3	0.8033
Curability of LR	Yes or no	0.9999
Lymphatic invasion (pathological ly factor)	Yes or no	0.9282
Vessel invasion (pathological v factor)	Yes or no	0.9999
Pathological differentiation	Tub vs others	0.9282
Pathological LN metastases	Yes or no	0.9999
Chemotherapy	Yes or no	0.9999

LMGC: Liver metastases originated from gastric cancer; LR: Liver resection; LN: Lymph node.

Table 5 Important factors for liver resection in patients with liver metastases originated from gastric cancer

Ref.	Year	Sample size	The 5-yr OS rate	Important factors for recurrences and/or poor prognoses
Ambiru et al[18]	2001	40	0.180	Synchronous LMGC
Okano et al[17]	2002	19	0.340	Multiple LMGC; synchronous LMGC; pathological differentiation
Zacherl et al[12]	2002	15	0	Multiple LMGC; bilobular LMGC; curability of LR
Saiura et al[19]	2002	10	0.200	LN metastases
Shirab et al[8]	2003	36	0.260	Number of LMGC (number of ≥ 3); curability of LR; lymphatic invasion; vessel invasion
Sasako et al[20]	2007	37	0.110	Bilobular LMGC; the greatest dimension (size of > 4 cm)
Cheon et al[16]	2008	41	0.208	Multiple LMGC
Makino et al[14]	2010	16	0.370	Bilobular LMGC
Tsujimoto et al[10]	2010	17	0.315	Multiple LMGC; the greatest dimension (size of > 6 cm); lymphatic invasion
Schildberg et al[15]	2012	31	0.130	Multiple LMGC; synchronous LMGC
Takemura et al[9]	2012	64	0.370	The greatest dimension (size of > 5 cm); serosal invasion
Matsuda et al[13]	2013	14	0.360	Synchronous LMGC; bilobular LMGC; no chemotherapy
Kinoshita et al[5]	2015	256	0.313	The greatest dimension (size of > 5 cm); serosal invasion; curability of LR; number of LMGC (number of ≥ 3)
Tatsubayashi et al[6]	2017	28	0.320	Synchronous LMGC
Our study	2020	30	0.480	Serosal invasion (pathological T factor)

OS: Overall survival; LMGC: Liver metastases originated from gastric cancer; LN: Lymph node; LR: Liver resection.