SYNCHRONOUS, METACHRONOUS, AND MULTIPLE HEPATIC RESECTIONS OF LIVER-TUMORS ORIGINATING FROM PRIMARY GASTRIC TUMORS

Background. The role of hepatic resection for noncolorectal gastrointe stinal malignancies involving the liver is not well defined, To addres s this issue we studied our experience with resection of liver tumors arising from primary gastric malignancies. Methods. A retrospective st udy of 1.95 patients ho underwent a total of 207 liver resections iden tified 12 patients with primary gastric cancer who underwent 16 resect ions for liver involvement. There were 10 adenocarcinomas and two leio myosarcomas. We examined the type of hepatic surgery, the status of re sidual disease, and the primary histologic findings. Morbidity mortali ty, and actual survival rates were recorded. Results. Thirty-day opera tive mortality was 8.3% (1 of 12). Hospital mortality was 25% (3 of 12 ). Operative morbidity occurred in three of nine survivors (33%). Sync hronous en bloc resection (n = 3) of stomach and liver for adenocarcin oma produced two long-term survivors (no evidence of disease for 10 an d 13 years). Mean survival after synchronous discontinuous resection ( n = 4) was 8 months (range, 2 to 17 months). Metachronous resection fo r adenocarcinoma (n = 3) produced one long-term survivor (74 months), and one patient with recurrent leiomyosarcoma underwent a total of fiv e liver resections and survived 64 months. Conclusions. For adenocarci noma, en bloc resection of contiguous liver involvement produced long- term survivors. Synchronous resection of discontinuous metastases did not. Metachronous resection of isolated disease and multiple resection s of recurrent isolated disease may have value in carefully selected p atients.