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J Korean Cancer Assoc > Volume 31(3); 1999 > Article
Journal of the Korean Cancer Association 1999;31(3): 441-447.
Effectiveness of Gastrectomy in Stage 4 Gastric Cancer with Hepatic Metastasis
Jeong Hwan Yook, Sung Joon Kwon, Byung Ki Kim, Byung Jae Kim, Sung Kim, Seung Moon Noh, Young Jae Mok, Kyung Kyu Park, Byung Ju Park, Cho Hyun Park, Ho Yoon Bang, Jae Moon Bae, Young Jin Song, Du Hyun Yang, Dae Hyun Yang, Sung Tae Oh, Hyo Yung Yun, Moo Son Lee, Jong Inn Lee, Yong Kwan Cho, Dong Wook Choi, Sang Uk Han
1Department of Surgery, College of Medicine, University of Ulsan, Korea.
2Members of Korean Gastric Cancer Study Group, Seoul, Korea.
The prognosis for patients with stage IV gastric cancer is very poor. However, recently, some studies have reported benefits from a gastric resection for metastatic gastric cancer. This clinical study was performed to evaluate the effectiveness of a noncurative gastrectomy in treating stage IV gastric cancer with hepatic metastasis.
A retrospective analysis was performed on 98 gastric cancer patients who had undergone gastric resection, in spite of hepatic metastasis, between January 1990 and December 1996 at the Department of Surgery in 11 General Hospitals in Korea.
The average age was 58 years old, and the male-to-female ratio was 69: 29. The laboratory tests were unable to predict hepatic metastasis. In 54 cases, hepatic metastasis was not identified before the surgery. The most common location of gastric cancer was antrum (72 cases). The most common gross type was Bonmann type III (78 cases). The serosa-exposed cases were 80. The peritoneal seeding was combined in 17 cases. A total gastrectomy was performed in 18 cases and a distal gastrectomy in 80. Lymph-node dissection was performed in 23 Dl, and 51 D2 cases. Hepatic resection was performed in 36 cases, The frequent histologic types were moderately differentiated and poorly differentiated tubular adenocarcinoma. Postoperative adjuvant chemotherapy was done in 70 cases. The complication rate (7%) was low. The median survival time was 15 months, with mean survival time of 18 months. The 2-year and 3-year survival rates were 23%, and 7%, respectively. In the univariate analysis, good survival was closely related to limitation of hepatic metastasis to one lobe, a few metastases to both lobes, negativity of peritoneal seeding and lymph node dissection more than D2 (p<0.05),
An aggressive gastric resection for stage IV gastric cancer with hepatic metastasis might be beneficial in lengthening the survival period. A prospective study is needed, especiaUy one with an exact evaluation and analysis of the quality of life between the gastrectomy and nonresection groups.
Key words: Hepatic metastasis;Gastrectomy;Survival time
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