Survival Outcomes of Hepatectomy in Gastric Cancer Liver Metastasis: A Systematic Review and Meta-Analysis

Abstract

Gastric cancer liver metastasis (GCLM) is a contraindication for surgical treatment in current guidelines. However, the results of recent studies are questioning this paradigm. We assessed survival outcomes and their predictors following hepatectomy for GCLM in a systematic review of studies published from 2000 to 2022 according to PRISMA guidelines. We identified 42,160 references in four databases. Of these, 55 articles providing data from 1990 patients fulfilled our criteria and were included. We performed a meta-analysis using random-effects models to assess overall survival (OS) and disease-free survival (DFS) at one, three, and five years post-surgery. We studied the impact of potential prognostic factors on survival outcomes via meta-regression. One, three, and five years after surgery, OS was 69.79%, 34.79%, and 24.68%, whereas DFS was 41.39%, 23.23%, and 20.18%, respectively. Metachronous presentation, well-to-moderate differentiation, small hepatic tumoral size, early nodal stage, R0 resection, unilobar compromisation, and solitary lesions were associated with higher overall survival. Metachronous presentation, smaller primary tumoral size, and solitary metastasis were linked to longer DFS. The results of our meta-analysis suggest that hepatectomy leads to favorable survival outcomes in patients with GCLM and provides data that might help select patients who will benefit most from surgical treatment.

Keywords: gastric cancer; hepatectomy; meta-analysis; mortality; survival.

Figure 1

Flow diagram depicting the flow of information through the different phases of our systematic review. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Forest plot of overall survival at 1 year after hepatectomy for gastric cancer liver metastasis (GCLM). Description of the proportion and confidence intervals at 95% in the studies that reported 1-year overall survival.

Figure 3

Forest plot of overall survival at 3 years after hepatectomy for gastric cancer liver metastasis (GCLM). Description of the proportion and confidence intervals at 95% in the studies that reported 3-year overall survival.

Figure 4

Forest plot of overall survival at 5 years after hepatectomy for gastric cancer liver metastasis (GCLM). Description of the proportion and confidence intervals at 95% in the studies that reported 5-year overall survival.

Figure 5

Forest plot of disease-free survival at 1 year after hepatectomy for gastric cancer liver metastasis (GCLM). Description of the proportion and confidence intervals at 95% in the studies that reported 1-year disease-free survival.

Figure 6

Forest plot of disease-free survival at 3 years after hepatectomy for gastric cancer liver metastasis (GCLM). Description of the proportion and confidence intervals at 95% in the studies that reported 3-year disease-free survival.

Figure 7

Forest plot of disease-free survival at 5 years after hepatectomy for gastric cancer liver metastasis (GCLM). Description of the proportion and confidence intervals at 95% in the studies that reported 5-year disease-free survival.