Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jul 24, 2020; 11(7): 477-494
Published online Jul 24, 2020. doi: 10.5306/wjco.v11.i7.477
Is there a role for treatment-oriented surgery in liver metastases from gastric cancer?
Fabio Uggeri, Lorenzo Ripamonti, Enrico Pinotti, Mauro Alessandro Scotti, Simone Famularo, Mattia Garancini, Luca Gianotti, Marco Braga, Fabrizio Romano
Fabio Uggeri, Lorenzo Ripamonti, Enrico Pinotti, Simone Famularo, Luca Gianotti, Marco Braga, Fabrizio Romano, School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
Mauro Alessandro Scotti, Mattia Garancini, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
Author contributions: Uggeri F and Romano F designed the review; Uggeri F and Ripamonti L performed the literature research and drafted the manuscript with Pinotti E; Garancini M, Romano F, Braga M, Gianotti L, Scotti MA and Famularo S performed a critical review of the manuscript; all authors approved the final manuscript as submitted.
Conflict-of-interest statement: The authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised in accordance with this checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fabio Uggeri, MD, Academic Research, Assistant Professor, Surgeon, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy. fabio.uggeri@unimib.it
Received: February 14, 2020
Peer-review started: February 14, 2020
First decision: May 28, 2020
Revised: June 5, 2020
Accepted: June 17, 2020
Article in press: June 17, 2020
Published online: July 24, 2020
Processing time: 156 Days and 15.3 Hours
Abstract
BACKGROUND

Distant metastases are found in approximately 35% of patients with gastric cancer at their first clinical observation, and of these, 4%-14% involves the liver. Unfortunately, only 0.4%-2.3% of patients with metastatic gastric cancer are eligible for radical surgery. Although surgical resection for gastric cancer metastases is still debated, there have been changes in recent years, although several clinical issues remain to be defined and that must be taken into account before surgery is proposed.

AIM

To analyze the clinicopathological factors related to primary gastric tumor and metastases that impact the survival of patients with liver metastatic gastric cancer.

METHODS

We performed a systematic review of the literature from 2000 to 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The study protocol was based on identifying studies with clearly defined purpose, eligibility criteria, methodological analysis, and patient outcome.

RESULTS

We selected 47 studies pertaining to the purpose of the review, which involved a total of 2304 patients. Median survival was 7-52.3 mo, median disease-free survival was 4.7-18 mo. The 1-, 2-, 3-, and 5-year overall survival (OS) was 33%-90.1%, 10%-60%, 6%-70.4%, and 0%-40.1%, respectively. Only five papers reported the 10-year OS, which was 5.5%–31.5%. The general recurrence rate was between 55.5% and 96%, and that for hepatic recurrence was between 15% and 94%.

CONCLUSION

Serous infiltration and lymph node involvement of the primary cancer indicate an unfavorable prognosis, while the presence of single metastasis or ≤ 3 metastases associated with a size of < 5 cm may be considered data that do not contraindicate liver resection.

Keywords: Hepatic metastases; Gastric cancer; Prognostic factor; Survival; Hepatectomy; Surgery

Core tip: Distant metastases are found in approximately 35% of patients with gastric cancer at first clinical observation; of these, 4%-14% involves the liver. Although surgical resection for gastric cancer metastases is still debated, there have been changes in recent years; however, there remain several clinical issues to be defined and that must be taken into account for proposing surgery. The purpose of the present study is to analyze in the current literature the clinicopathological factors related to primary cancer and metastases that impact the survival of patients with metastatic gastric cancer to the liver.