Surgical resection of metachronous liver metastases

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Surgical resection of metachronous liver metastases from advanced gastric cancer Sung Hyun Kim, Dai Hoon Han, Gi Hong Choi, Kyung Sik Kim, Jin Sub Choi Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine Treatment & Environment

Introductions Metachronous liver metastases from stomach cancer Metachronous liver metastases are observed in about 50% of stomach cancer patients during the course of the disease. However, the role of surgical therapy in patients with metachronous liver metastases from stomach cancer is still controversial. Yonsei University College of Medicine

Introductions Aim of study To evaluate benefit of surgical resection for metachronous liver metastasis from stomach cancer Yonsei University College of Medicine

Methods Period : January 1997 ~ December 2011 Materials : Metachronous and solely liver metastases patients who underwent radical gastrectomy due to stomach cancer Exclusion criteria : Early gastric cancer Multiple liver metastases (>3) No treatment patients Primary end point : Overall survival (OS) Yonsei University College of Medicine

Liver metastases Pt. (N=180) Methods Liver metastases Pt. (N=180) Surgery (N=33) Chemotherapy (N=40) Exclusion (N=107) Exclusion criteria 1. Early gastric cancer 2. Multiple liver metastases 3. No treatment patients Yonsei University College of Medicine

Results Basal characteristics n=73 Gender (M : F) 61 : 12 (5.1 : 1) n=73 Gender (M : F) 61 : 12 (5.1 : 1) Age (Stomach cancer, yr) 60.0 ± 9.9 Age (Liver metastases, yr) 61.4 ± 10.1 DFS without liver metastases (m) 14.9 ± 16.6 Tumor location Upper 13 (17.8%) Middle 17 (23.3%) Lower 43 (58.9%) Stomach operation Subtotal 46 (63.0%) Total 27 (37.0%) Stomach tumor size (cm) 4.9 ± 2.3 TNM stage I 2 (2.7%) II 31 (42.5%) III 40 (54.8%)

Results Basal characteristics n=73 Differentiation Differentiated n=73 Differentiation Differentiated 44 (60.3%) Undifferentiated 25 (34.2%) Others 4 (5.5%) LVI (N=62) 43 (69.4%) PNI (N=51) 24 (47.1%) Recur mass size 2.7 ± 1.9 Recur number 1 50 (68.5%) 2-3 23 (31.5%) Treatment modality Surgery 33 (45.2%) Chemotherapy 40 (54.8%)

Results Clinicopathologic characteristics according to treatment modality Surgery (N=33) Chemotherapy (N=40) p value Gender (M : F) 26 : 7 (3.7 : 1) 35 : 5 (7.0 : 1) 0.357 Age (Stomach cancer, yr) 58.6 ± 9.6 61.2 ± 10.1 0.272 Age (Liver metastases, yr) 59.9 ± 9.7 62.6 ± 10.3 0.260 DFS (m) 14.5 ± 13.6 15.3 ± 18.8 0.835 Tumor location 0.947 Upper 6 (18.2%) 7 (17.5%) Middle 7 (21.2%) 10 (25.0%) Lower 20 (60.6%) 23 (57.5%) Stomach operation 0.630 Subtotal 22 (66.7%) 24 (60.0%) Total 11 (33.3%) 16 (40.0%) Stomach tumor size 4.3 ± 1.6 5.3 ± 2.7 0.060

Results Clinicopathologic characteristics according to treatment modality Surgery (N=33) Chemotherapy (N=40) p value TNM stage 0.273 I 2 (6.0%) 0 (0.0%) II 15 (45.5%) 16 (40.0%) III 16 (48.5%) 24 (60.0%) Differentiation 0.186 Differentiated 22 (66.7%) 22 (55.0%) Undifferentiated 8 (24.2%) 17 (42.5%) Others 3 (9.1%) 1 (2.5%) LVI (N=62) 18 (60.0%) 25 (78.1%) 0.170 PNI (N=51) 11 (40.7%) 13 (54.2%) 0.406 Recur size 2.5 ± 1.1 2.8 ± 2.4 0.386 Recur number <0.999 1 23 (69.7%) 27 (67.5%) 2-3 10 (30.1%) 13 (32.5%)

Results Surgery Median 29.1m CTx. Median 17.8m Overall survival rate according to treatment modality P < 0.001 Surgery Median 29.1m CTx. Median 17.8m Yonsei University College of Medicine

Results Association of candidate prognostic variables with survival Factor N Survival (%) Uni p Multi p Risk Ratio (CI 95%) 1 yr 2 yr 3 yr Factors related to the stomach cancer TNM stage ≤ II 33 85 47 30 0.362 0.551 1.18 (0.68-2.04) ≥ III 40 73 44 18 Differentiation Differentiated 80 46 25 0.201 0.358 2.08 (0.44-9.84) Undifferentiated 76 14 Factors related to the liver metastases Disease free survival ≤ 12 months 75 45 19 0.250 0.258 1.38 (0.79-2.43) > 12 months 29 83 31 Maximum size ≤ 2.5 cm 50 26 0.344 0.758 1.26 (0.30-5.34) > 2.5 cm 28 39 Number 1 0.417 0.707 1.22 (0.44-3.38) 2-3 23 74 Factors related to the treatments Treatment Surgery 91 69 42 <0.001 2.95 (1.67-5.23) Chemotherapy 68 8

Conclusions Surgical resection of metachronous liver metastases Can improve patients’ survival comparing to chemotherapy Yonsei University College of Medicine

Thank you for your attention. Treatment & Environment