Hepatectomy Offers Superior Survival Compared with Non-surgical Treatment for ≤3 Metastatic Tumors with Diameters <3 cm from Gastric Cancer: A Retrospective Study

A consensus has almost been reached in favor of hepatic resection for colorectal cancer metastases. It remains unclear whether resection of gastric cancer metastases in the liver is justified. The purpose of this study was to assess the survival benefit of surgical resection for gastric cancer metastases confined to the liver. We reviewed the clinicopathological features and outcome of 107 patients with liver metastases without other non-curative factors from the case records of 5437 gastric cancer patients. These subjects included 34 synchronous cases with tumors present at the time of gastrectomy and 73 metachronous cases with new lesions that appeared after radical gastrectomy. Hepatectomies were performed in nine synchronous and four metachronous cases that had a parts per thousand currency sign3 tumors with diameters < 3 cm. The overall survival rates after hepatectomy were significantly higher than those in eligible candidates who did not receive hepatectomy despite having comparable metastatic status (synchronous, n = 8, p = 0.009; metachronous, n = 24, p = 0.016). The survival rate of patients who underwent hepatectomy for synchronous metastases was not inferior to that of patients who underwent hepatectomy for metachronous metastases. The median disease-free interval in metachronous cases was significantly shorter in patients who did not undergo resection than those who underwent resection. However, multivariate analyses revealed that hepatectomy was the only significant (p = 0.001) prognostic factor whereas DFI was not. Hepatectomy for a parts per thousand currency sign3 metastatic tumors with diameters < 3 cm offered superior survival compared with non-surgical treatment even for metastases detected synchronously or within a short period after radical gastrectomy.