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

are described in Table 1 and Supplementary Table 1. The median age of patients undergoing hepatectomy
was 64 years (range 57-72 years) and 78% of patients were males. There was a wide variety of disease burden
in patients undergoing hepatectomy. Hepatic lesions were solitary and unilobar in 65% and 78% respectively.
Fifty five percent of patients developed synchronous metastases, while 45% developed metachronous lesions.
The majority of hepatectomies were minor resections for limited disease, although 42% of patients underwent
major resections.

Details on chemotherapy used were also reported in 19 studies, including data on 775 patients. Of these,
15% received neoadjuvant chemotherapy and 46% received adjuvant chemotherapy. A wide variety of
chemotherapy regimens were described, while seven studies did not state what chemotherapeutic agents
their patients received [18,23,24,29,34,39,41] .

Survival outcomes are summarized in Table 2. Median follow-up was 24 months (range 9-65 months).
Twenty-one studies presented 1-year survival rates ranging from 36% to 96%, 19 presented 3-year survival
rates ranging from 14% to 70% and 25 studies presented 5-year survival rates of between 9% to 42%. Median
survival rates were 73%, 37% and 27% at 1-, 3- and 5-year respectively. Median overall survival was 22 months
(range 9-52 months).

Seven of the 26 studies compared survival outcomes between resected patients and those who underwent
chemotherapy alone. Surgery demonstrated a survival advantage in all of them.

Pulmonary metastasis surgical treatment
Eighty-three patients provided by four studies underwent resection of pulmonary metastases from gastric
cancers. Resection of gastric cancer lung metastases has rarely been reported and few data are available
regarding short- and long-term outcomes of this procedure. The majority of patients with pulmonary
metastases from gastric cancer present with carcinomatous lymphangitis or pleuritis, whereas nodular
[56]
lesions are less common .

Baseline characteristics are described in Table 3 and Supplementary Table 2. Median age was 66 years (range
56-68 years), and males represented the majority of resected patients (83% vs. 17%). All patients underwent
gastrectomy and subsequent pulmonary metastasectomy. Hundred percent of included patients displayed
metachronous metastases and 73% of these were solitary lesions. Overall 39% of patients underwent
lobectomy, while wedge resection or segmentectomy was performed in 61%. In 3 studies [45-47] , indications
for performing surgery were decided based on Thomford’s criteria . Shiono et al. did not specify the
[57]
[44]
criteria for surgical resection. Details on chemotherapy were reported in 3 studies. No patients underwent
neoadjuvant chemotherapy, while adjuvant treatment was carried out in 42% of patients.

Median follow-up was 25 months (range 18-27 months). Overall survival outcomes are summarized in Table 3.
[47]
[46]
Iijima et al. reported an overall 3-year survival rate of 30%. Kobayashi et al. showed a median survival time
following pulmonary resection of 67 months and an overall 5-year survival rate of 59%, while Shiono et al.
[44]
[45]
reported a value of 28%. By contrast, Yoshida et al. followed patients for a median time of 27 months and the
overall survival rates at 1, 3 and 4 years were 100%, 100%, and 75%, respectively. None of the included studies
reported data regarding palliative treatment arms involving chemotherapy alone.
Palliative gastrectomy
Nine studies providing data on 1115 patients who underwent palliative gastric resection were included [Table 4].
One of these was a randomized controlled trial (REGATTA) . The median sample size was 137 patients (range
[58]
23-218), and 68% of patients were males. Except for the randomized controlled trial, inclusion criteria and study
structure were very heterogeneous between series and, consequently a comparison of results between them was