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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 7 of 11

Table 2. Survival outcomes following hepatectomy for liver metastasis from gastric cancer, with a comparison with
nonresected patients (chemotherapy alone)
Study 1-year survival 3-year survival 5-year survival Median survival Nonresected P value
(%) (%) (%) (months) patients,
median OS
(months)
Baek et al. [18] 65 NR 39 31 - -
Chen et al. [19] NR NR 15 22 5.5 0.000
Cheon et al. [20] 75 32 21 17 NR 0.0001
Dittmar et al. [21] NR NR 27 48 9 0.002
Garancini et al. [22] 68 31 19 11 - -
Kinoshita et al. [23] 77 42 31 31 - -
Koga et al. [24] 76 48 42 34 - -
Komeda et al. [25] 78 40 40 22 - -
Li et al. [26] 74 37 25 26 3.13 0.001
Liu et al. [27] 58 22 NR 15 - -
Makino et al. [28] 88 56 42 38 15 0.001
Miki et al. [29] 74 43 37 33 NR 0.04
Morise et al. [30] 56 27 27 13 - -
Nomura et al. [31] NR NR 31 21 - -
Qiu et al. [32] 96 70 29 38 - -
Roh et al. [33] 73 NR 27 19 - -
Sakamoto et al. [34] 73 38 38 21 - -
Sakamoto et al. [35] NR NR 11 31 - -
Takemura et al. [36] 84 50 37 34 - -
Thelen et al. [37] 38 16 10 9 - -
Tiberio et al. [38] 50 14 9 13 - -
Tsujimoto et al. [39] NR NR 32 34 - -
Viganò et al. [40] 95 63 33 52 - -
Wang et al. [41] 43 17 17 11 - -
Wang et al. [42] 56 18 10 14 NR NR
(but referred
< 0.05)
Zacherl et al. [43] 36 29 14 9 - -
NR: not reported; OS: overall survival

Resection of lung metastases from gastric cancer has rarely been reported, and only small amounts of
heterogeneous data are available regarding short- and long-term outcomes. The majority of articles present
in the literature are case reports or small series. Only four studies were included in our evaluation. They
reported favorable results in the surgical group; however, the series were small, and comparison between
studies was difficult because of the heterogeneity of inclusion criteria for each study. Overall 3-year survival
rates ranged from 30% to 100%. The frequent occurrence of extrapulmonary metastases before pulmonary
metastasectomy restricts surgical treatment to highly selected patients . In this setting, lung metastasectomy
[56]
seems not to have a determined role in the standard management of these patients.

In the 1115 patients included in this review who underwent palliative gastrectomy, median overall post-
resection survival was 12 months. The rationale for non-curative gastrectomy was the reduction of tumor
burden and/or the palliation of symptoms, such as obstruction, perforation, bleeding or ascites. In 6 of
the 8 retrospective studies included in this review, overall survival of resected patients was significantly
better than the nonresected group. However, all studies highlighted as a limitation, the possible relationship
between these positive results and the selection bias of patients. A previous meta-analysis was consistent
[62]
with these results . Moreover, they analyzed survival rates of patients that received palliative gastrectomy
with or without chemotherapy, and it was shown that surgery combined with chemotherapy offered a
survival benefit . By contrast, the results of the REGATTA trial showed no survival benefit of additional
[62]
gastrectomy over chemotherapy alone, not justifying gastric resection in patients with metastatic gastric
cancer . In light of this randomized controlled trial, chemotherapy alone remains the standard of care for
[58]