1. 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

2. 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

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

4. 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

5. 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 Multiple liver metastases No treatment patients
Yonsei University College of Medicine

6. 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%)

7. 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%)

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

9. 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%)

10. 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

11. 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 ( )
≥ III 40 73 44 18
Differentiation
Differentiated 80 46 25
0.201
0.358
2.08 ( )
Undifferentiated 76 14
Factors related to the liver metastases
Disease free
survival
≤ 12 months 75 45 19
0.250
0.258
1.38 ( )
> 12 months 29 83 31
Maximum size
≤ 2.5 cm 50 26
0.344
0.758
1.26 ( )
> 2.5 cm 28 39
Number 1
0.417
0.707
1.22 ( )
2-3 23 74
Factors related to the treatments
Treatment
Surgery 91 69 42
<0.001
2.95 ( )
Chemotherapy 68 8

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

13. Thank you for your attention.
Treatment & Environment