Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, Japan.
Langenbecks Arch Surg. 2012 Aug;397(6):951-7. doi: 10.1007/s00423-012-0959-z. Epub 2012 May 22.
The indication for hepatectomy in cases of gastric cancer liver metastases (GLM) remains unclear and it remains controversial whether surgical resection is beneficial for GLM. The objective of this retrospective study was to clarify the indications for and benefit of hepatectomy for GLM.
Seventy-three patients underwent hepatectomies for GLM from January 1993 to January 2011. Macroscopically complete (R0 or R1) resection was achieved in 64 patients. Among them, 32 patients underwent synchronous hepatectomy with gastrectomy and the remaining 32 patients underwent metachronous hepatectomy. Repeat hepatectomy was done in 14 patients for resectable intrahepatic recurrences. Clinicopathological factors were evaluated by univariate and multivariate analyses among patients who received macroscopically complete resection for those affecting survival.
The overall 1-, 3-, and 5-year survival rates after macroscopically complete (R0 or R1) liver resection (n = 64) for GLM were 84, 50, and 37 %, respectively, with a median survival of 34 months. Univariate analysis identified serosal invasion of the primary gastric cancer and blood transfusions during surgery as poor prognosis indicators. By multivariate analysis, serosal invasion of the primary gastric cancer and larger hepatic tumor (>5 cm in diameter) were found to be independent indicators of poor prognosis.
GLM patients with the maximum diameter of hepatic tumors of <5 cm and without serosal invasion of the primary gastric cancer are the best candidate for hepatectomy.
胃癌肝转移（GLM）患者行肝切除术的适应证仍不明确，手术切除是否有利于 GLM 尚存争议。本回顾性研究旨在阐明 GLM 行肝切除术的适应证和获益。
1993 年 1 月至 2011 年 1 月，73 例患者因 GLM 行肝切除术。64 例患者达到肉眼下完全（R0 或 R1）切除。其中 32 例患者行同步肝胃切除术，32 例患者行异时性肝切除术。14 例患者因可切除的肝内复发而行重复肝切除术。对接受肉眼下完全切除的患者，通过单因素和多因素分析评估与生存相关的临床病理因素。
64 例 GLM 患者行肉眼下完全（R0 或 R1）肝切除术后的总体 1、3 和 5 年生存率分别为 84%、50%和 37%，中位生存时间为 34 个月。单因素分析显示原发胃癌的浆膜侵犯和手术期间输血是预后不良的指标。多因素分析显示，原发胃癌的浆膜侵犯和较大的肝肿瘤（直径>5cm）是独立的预后不良指标。
肝肿瘤最大直径<5cm 且原发胃癌无浆膜侵犯的 GLM 患者是肝切除术的最佳候选者。
