The
clinical significance of hepatic resection for gastric
metastases is controversial, even though hepatic resection has been widely accepted as a modality for colorectal
metastases. Very few
patients with gastric hepatic
metastases are good candidates for hepatic resection because of multiple bilateral
metastases, extrahepatic
disease, or advanced
cancer progression, such as peritoneal dissemination or extensive
lymph node metastases. Therefore, several authors have reported the
clinical significance of hepatic resection for gastric
metastases in a small number of
patients. Considering the present results with previous
reports. The number and distribution of
tumors in hepatic
metastases from
gastric cancer was considered based on the present and previous
reports. Several authors have reported significantly better
survival in
patients with metachronous
metastasis than in those with synchronous
disease. However, metachronous hepatic resection necessitates the
dissection of adhesions between the
pancreas,
liver, and
residual stomach to prepare for Pringle's maneuver.
Patients with unilobar
liver metastasis, and/or metastatic
tumors <4 cm in diameter may be good candidates for hepatic resection. Synchronous
metastasis is not a
contraindication for hepatic resection. Most of the
long-term survivors underwent anatomic hepatic resection with a sufficient
resection margin. After hepatic resection, the most frequent site of
recurrence was the remaining
liver, which was associated with a high frequency of
mortality within 2 years. A reasonable strategy for improvement in
survival would be to prevent
recurrence by means of
adjuvant chemotherapy and careful
follow-up studies.