Surgical resection of synchronous liver metastases in gastric cancer patients. A propensity score-matched study

Figure 1

Figure 2

Morbidity and mortality of additional resections in in the control group of patients without liver metastases and stage III and IV resectable gastric cancer (CG)

	N (%)	Morbidity (%)	Mortality (%)
Gastrectomy
Subtotal	4(19)	0(0)	1(25)
Total	12(57.1)	2(16.6)	1(25)
Total with distal esophagectomy	4(19)	1(25)	0(0)
Stump resection	1(4.8)	0(0)	0(0)
Additional resection
No additional resection         Local peritonectomy         Left splenopancreatectomy and         segmental colon resection	11(52.4) 8(4.8) 1(4.8)	1(9.1) 1(12.5) 0(0)	2(18.2) 0(0) 0(0)
Left left adrenal splenopancreatectomy resection and	1(4.8)	1(100)	0(0)

Characteristics of liver resections in the group of patients with synchronous liver metastases and gastric resection with curative intent (LMR)

	n(%)
Segment involvement
I	0(0)
II	2(8.6)
II/III	3(13)
III	9(39.1)
IV	2(8.6)
V	2(8.6)
VI	0(0)
VII	3(13)
VIII	2(8.6)
Liver resection
Metastasectomia of 1 metastasis	12(57.1)
Metastasectomia of >1 metastasis	3(14.3)
Segmental resection	3(14.3)
Hepatectomy	1(4.8)
Radio frequency ablation	2(9.5)
Dindo-Claviene morbidity
0	18(85.7)
II	1(4.8)
IIIa	0(0)
IIIb	1(4.8)
V	1(4.8)
Number of metastases
1 metastasis	19(90.5)
2–3 metastasis	2(9.5)
> 3 metastasis	0(0)

Patients’, tumour and operations characteristics of the included patients

		PSM groups
	All patients	LM0	LMR	CG	p
Age [years ± SD]	64.43 ± 9.9	64.9 ± 6.9	65.5 ± 10	62.7 ± 12.5	NS
Gender [n(%)]
Male	50(79.4)	17(81)	16(76.2)	17(81)	NS
Female	13(20.6)	4(19)	5(23.8)	4(19)
CA 19-9 [ng(IQR)]	13(64.7)	20(32)	7(62)	5.5(351.7)	NS
CEA [ng(IQR)]	4(6.5)	3.5(26.7)	4(6)	3(17.25)	NS
Hb [g/l(IQR)]	112.5(28.25)	117.5(25)	105(41)	107(27.5)	NS
Chemotherapy [n(%)]
Yes	19(30.2)	1(4.8)	9(42.9)	9(42.9)	0.004
No	44(69.8)	20(95.2)	12(57.1)	12(57.1)
Dindo-Claviene
0	50(79.4)	16(76.2)	18(85.7)	16(76.2)
II IIIa	3(4.8) 1(1.6)	1(4.8) 0(0)	1(4.8) 0(0)	1(4.8) 1(4.8)	NS
IIIb	2(3.2)	0(0)	1(4.8)	1(4.8)
V	7(11.1)	4(19)	1(4.8)	2(9.5)
TNM T stage [n(%)]
1	5(7.9)	0(0)	2(9.5)	3(14.3)
2	1(1.6)	0(0)	0(0)	1(4.8)
3	36(57.1)	17(81)	8(38.1)	11(52.4)	NS
4a	8(12.7)	2(9.5)	3(14.3)	3(14.3)
4b	13(20.6)	2(9.5)	8(38.1)	3(14.3)
TNM N stage [n(%)]
0	6(11.1)	0(0)	3(14.3)	3(15)
1 2	5(9.3)	3(23.1)	2(9.5)	0(0)	NS
2	15(27.8)	3(23.1)	8(38.1)	4(20)
3a	9(16.7)	1(7.7)	3(14.3)	5(25)
3b	19(35.2)	6(46.2)	5(23.8)	8(40)
UICC stage [n(%)]
IIIa	2(3.2)	0(0)	1(4.8)	1(4.8)
IIIc	4(6.3)	0(0)	2(9.5)	2(9.5)	NS
IV	57(90.5)	21(100)	18(85.7)	18(85.7)
Positive LNs [n(IQR)]	7(17.7)	11(23)	5.5(18.7)	12.5(12.2)
All LNs [n±SD]	28.2±11.5	18±9	27.6±14.6	26±17	0.028
Grade [n(%)]
Well Moderate	6(12.5)	2(16.7)	2(10)	2(12.5)	NS
Moderate	13(27.1)	4(33.3)	5(25)	4(25)	NS
Poor	29(60.4)	6(50)	13(65)	10(62.5)
Type [n(%)] of gastrectomy
Subtotal	22(34.9)	12(57.1)	6(28.6)	4(19)
Total	34(54)	8(38.1)	14(66.7)	12(57.1)
Total with distal esophagectomy	4(3.2)	0(0)	0(0)	4(19)	NS
Distal esophagectomy & proximal	2(1.6)	1(4.8)	1(4.8)	0(0)
gastrectomy Stump resection	1(1.6)	0(0)	0(0)	1(4.8)
Location [n(%)]
Stump	1(1.6)	0(0)	0(0)	1(4.8)
Entire	6(9.5)	2(9.5)	9(42.9)	3(14.3)
Proximal	10(15.9)	2(9.5)	9(42.9)	6(28.6)	0.045
Middle	20(31.7)	6(28.6)	2(9.5)	5(23.8)
Distal	26(41.3)	11(52.4)	1(4.8)	6(28.6)
ASA score [n(%)]
I	16(25.4)	6(28.6)	6(28.6)	4(19)	NS
II	32(50.8)	9(42.9)	12(57.1)	11(52.4)
III	15(23.8)	6(28.6)	3(14.3)	6(28.6)
Lymphadenectomy [n(%)]
D1	26(41.3)	17(81)	5(23.8)	4(19)	< 0.0001
D2	37(58.7)	4(19)	16(76.2)	17(81)
R0 [n(%)]	39(61.9)	0(0)	18(85.7)	21(100)	< 0.0001
Number metastases of liver [n(%)]
1	23(54.8)	4(19)	19(90.5)	0(0)	< 0.0001
2–3	4(9.5)	2(9.5)	2(9.5)	0(0)
> 3	15(35.7)	15(71.4)	0(0)	0(0)
Grade [n(%)]
Well	6(9.5)	2(16.7)	2(10)	2(12.5)
Moderate	13(27.1)	4(33.3)	5(25)	4(25)	NS
Poor	29(60.4)	6(50)	13(65)	10(62.5)
Hospital stay [n(IQR)]	13(8.5)	12(6.5)	13.5(8)	14(12.7)	NS

Characteristics of liver metastases and recurrence sites in the group of patients with synchronous liver metastases and gastric resection with curative intent (LMR)

Case No.	Involved segment	Number of metastases	Type of resection	Recurrence site
1	II	1	Segmentectomy	0
2	IV	1	Metastasectomy	0
3	III	1	Segmentectomy	carcinomatosis Peritoneal
4	II/III	1	Segmentectomy	Liver metastases
5	III	1	Metastasectomy	0
6	VII	1	Metastasectomy	0
7	III	1	Metastasectomy	recurrence Local
8	III	1	Segmentectomy	carcinomatosis Peritoneal
9	VIII	1	Metastasectomy	Liver metastases
10	III	1	Segmentectomy	0
11	V	1	Metastasectomy	recurrence Local
12	IV, II	3	Metastasectomy	Liver metastases
13	II/III	1	Metastasectomy	Liver metastases
14	III	1	Metastasectomy	0
15	II/III	1	secienectomy Left lateral	0
16	III	1	Metastasectomy	0
17	III	1	Metastasectomy	carcinomatosis Peritoneal
18	V, VIII	2	Metastasectomy	Liver metastases
19	VII	1	Radio frequency ablation	Liver and metastases peritoneal carcinomatosis
20	VII	1	Radio ablation frequency	0
21	III	1	Segmentectomy	0

Cox proportional hazard model for survival after gastric cancer resection with liver metastases

	HR	95% CI		p
		Lower	Upper
Age	1.497	1.213	1.846	<0.0001
Gender	55.237	4.626	659.594	0.002
ASA score	0.049	0.009	0.261	<0.0001
Ca 19-9	1	1	1.001	0.02
Hb	0.918	0.864	0.974	0.005
Additional liver resection	0.001	0	0.029	<0.0001
Tumour grade	8.276	1.971	34.753	0.004
UICC stage	0	0	0.003	0.002
TNM N stage	0.386	0.163	0.917	0.031