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Pergolini et al. J Cancer Metastasis Treat 2018;4:33 I http://dx.doi.org/10.20517/2394-4722.2017.84 Page 3 of 11

Papers indentified by
PubMed (n = 2434)
Records excluded after
review of titles (n = 2346)

Abstracts (n = 88)

Records excluded after
review of abstracts (n = 36)

Full papers reviewed (n = 52)

Irrelevant excluded (n = 14)

Included papers (n = 39)
Liver metastasis (n = 26)
Pulmonary metastasis (n = 4)
Palliative gastrectomy (n = 9)

Figure 1. Diagram showing literature selection strategy

• Papers presenting data on patients undergoing palliative gastrectomy, defined as gastric resection without
radical intent (microscopic or macroscopic residual disease) in patients with locally advanced disease or
in patients with distant metastases.
• Original data (no review papers).
• Survival outcomes data available for at least 1 year following surgical resection. Papers relating to hepatic
metastases must have reported at least the median survival time.
• Patient recruitment after 1980.

Exclusion criteria
• Non-English language studies.
• Full manuscript not available (e.g., abstracts presented at conferences).
• Studies with less than ten patients.
• Malignancy other than epithelial carcinoma [16,17] .

The following data were collected: author details, country, recruitment period, study design, median follow-
up, sample size, gender, positive and negative findings, and methodological quality. The primary outcome
assessed was survival following surgical resection.

Considering the extreme heterogeneity of inclusion criteria of each paper, we aimed to review the literature
descriptively without an intent of inference.

RESULTS
The original search returned 2434 papers. Figure 1 shows the study search strategy. Overall, 39 studies were
included in the final review (26 for hepatic resection [18-43] , 4 for pulmonary resection [44-47] and 9 for palliative
gastrectomy [48-55] ).

Liver metastasis surgical treatment
The 26 studies included provided data on 933 patients who underwent gastrectomy and synchronous or
metachronous hepatectomy. The median sample size was 24 patients (range 11-256). Baseline characteristics