Response to preoperative chemotherapy predicts survival in patients undergoing hepatectomy for liver metastases from gastric and esophageal cancer.

Abstract

BACKGROUND:

The role of hepatectomy for patients with liver metastases from gastric and esophageal cancer (GELM) is not well defined. The present study examined the morbidity, mortality, and long-term survivals after liver resection for GELM.

METHODS:

Clinicopathological data of patients who underwent hepatectomy for GELM between 1995 and 2012 at two European high-volume hepatobiliary centers were assessed, and predictors of overall survival (OS) were identified. In addition, the impact of preoperative chemotherapy for GELM on OS was evaluated.

RESULTS:

Forty-seven patients underwent hepatectomy for GELM. The primary tumor was located in the stomach, cardia, and distal esophagus in 27, 16, and 4 cases, respectively. Twenty patients received preoperative chemotherapy before hepatectomy. After a median follow-up time of 76 months, 1-, 3-, and 5-year OS rates were 70, 37, and 24%, respectively. Postoperative morbidity and mortality rates were 32 and 4%, respectively. Outcomes were comparable between the two centers. Preoperative chemotherapy for GELM (5-year OS: 45 vs 9%, P = .005) and the lack of posthepatectomy complications (5-year OS: 34 vs 0%, P < .0001) were significantly associated with improved OS in univariate and multivariate analyses. When stratifying OS by radiologic response of GELM to preoperative chemotherapy, patients with progressive disease despite preoperative treatment had significantly worse OS (5-year OS: 0 vs 70%, P = .045).

CONCLUSION:

For selected patients with GELM, liver resection is safe and should be regarded as a potentially curative approach. A multimodal treatment strategy including systemic therapy may provide better patient selection resulting in prolonged survival in patients with GELM undergoing hepatectomy.

• Authors: Andreas Andreou, Luca Viganò, Giuseppe Zimmitti, Daniel Seehofer, Martin Dreyer, Andreas Pascher, Marcus Bahra, Wenzel Schoening, Volker Schmitz, Peter C Thuss-Patience, Timm Denecke, Gero Puhl, Jean-Nicolas Vauthey, Peter Neuhaus, Lorenzo Capussotti, Johann Pratschke, Sven-Christian Schmidt
• Journal: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (J Gastrointest Surg) Vol. 18 Issue 11 Pg. 1974-86 (Nov 2014) ISSN: 1873-4626 [Electronic] United States
• PMID: 25159501 (Publication Type: Comparative Study, Journal Article, Multicenter Study)

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Cohort Studies
• Disease-Free Survival
• Esophageal Neoplasms (mortality, pathology, surgery)
• Female
• Follow-Up Studies
• Hepatectomy (methods, mortality)
• Hospital Mortality
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms (mortality, secondary, therapy)
• Male
• Middle Aged
• Multivariate Analysis
• Neoadjuvant Therapy (methods)
• Predictive Value of Tests
• Preoperative Care (methods)
• Prognosis
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Statistics, Nonparametric
• Stomach Neoplasms (mortality, pathology, surgery)
• Survival Analysis
• Treatment Outcome
• Young Adult