The role of surgical resection for stage IV gastric cancer with synchronous hepatic metastasis

Omar Picado, Levi Dygert, Francisco Igor Macedo, Dido Franceschi, Danny Sleeman, Alan S. Livingstone, Nipun Merchant, Danny Yakoub

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: With improved responses to chemotherapy and targeted treatments, the role of surgery in metastatic gastric cancer (MGC) to the liver needs to be revisited. We sought to examine whether surgical resection is associated with improvement of long-term survival. Methods: The National Cancer Database was queried for MGC to the liver (2010-2014). Survival analysis was performed to compare the effect of gastrectomy and perioperative chemotherapy (G-CT) to palliative chemotherapy (PCT) alone. Results: We identified 3175 patients with MGC to the liver. Most patients (94%, n = 2979) were treated with PCT, whereas 6% (n = 196 patients) underwent G-CT. Overall survival improved in patients treated with G-CT compared to PCT alone (16 versus 9.7 mo, P < 0.001). In patients undergoing G-CT, neoadjuvant chemotherapy was associated with increased overall survival compared to adjuvant chemotherapy (18.9 versus 14.8 mo, P = 0.011). Hazards of death significantly decreased with gastrectomy (hazard ratio [HR]: 0.53, 95% confidence interval [CI]: 0.44-0.63, P < 0.001). Negative prognostic factors included advanced age (HR: 1.10, 95% CI: 1.06-1.14, P < 0.001), treatment at nonacademic institution (HR: 1.23, 95% CI: 1.13-1.33, P < 0.001), and poorly differentiated grade (HR: 1.54, 95% CI: 1.17-2.03, P < 0.001). Conclusions: G-CT is associated with improved survival in patients with gastric cancer and synchronous liver metastasis. Further experience with well-designed prospective trials may be warranted to confirm these findings.

Original languageEnglish (US)
Pages (from-to)422-429
Number of pages8
JournalJournal of Surgical Research
StatePublished - Dec 2018
Externally publishedYes


  • Chemotherapy
  • Gastrectomy
  • Gastric cancer
  • Liver metastasis

ASJC Scopus subject areas

  • Surgery


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