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. 2025 Jan;32(1):391-398.
doi: 10.1245/s10434-024-16318-1. Epub 2024 Sep 30.

The Role of Metastasectomy in Patients with Liver-Only Metastases from Gastric Adenocarcinoma

Ioannis A Ziogas  1 , Otto N Thielen  2 , Sumaya Abdul Ghaffar  2 , Elliott J Yee  2 , Andrii Khomiak  2 , Jakob A Durden  2 , Sunnie Kim  3 , Richard D Schulick  2 , Ana L Gleisner  2 , Martin D McCarter  2 , Benedetto Mungo  2
Affiliations

The Role of Metastasectomy in Patients with Liver-Only Metastases from Gastric Adenocarcinoma

Ioannis A Ziogas et al. Ann Surg Oncol. 2025 Jan.

Abstract

Background: The role of metastasectomy in patients with liver-only metastases from gastric adenocarcinoma remains under investigation. Therefore, we performed a national registry analysis comparing surgical treatment options for patients with gastric adenocarcinoma and liver-only metastases.

Patients and methods: In this retrospective National Cancer Database (2010-2019) study, adults (≥ 18 years) with gastric adenocarcinoma and liver-only metastases (no brain, bone, or lung metastases) were included. Patients were stratified into four groups: no surgical treatment, primary tumor resection (PTR), liver metastasectomy, and PTR with liver metastasectomy. Survival was evaluated using the Kaplan-Meier method, log-rank test, and Cox regression.

Results: Of 10,977 included patients, 93.6% underwent no surgical treatment, 4.6% PTR alone, 0.8% liver metastasectomy alone, and 1.0% both PTR and liver metastasectomy. The median OS after no surgical treatment was 6.5 months, after PTR alone 10.9 months, after liver metastasectomy alone 9.9 months, and after PTR and liver metastasectomy 18.6 months. In multivariable analysis, when adjusting for age, sex, race/ethnicity, insurance status, Charlson-Deyo score, chemotherapy, and radiation, PTR and liver metastasectomy was associated with superior OS compared with no surgical treatment (HR 2.17, 95% CI 1.76-2.69, p < 0.001), PTR alone (HR 1.42, 95% CI 1.12-1.79, p = 0.003), and liver metastasectomy alone (HR 1.96, 95% CI 1.45-2.64, p < 0.001).

Conclusions: These data suggest that, in highly selected patients with gastric adenocarcinoma and synchronous liver-only metastases and favorable biology, surgical resection might grant a survival advantage.

Keywords: Gastric adenocarcinoma; Liver metastasis; Metastasectomy; Oligometastatic disease.

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