Hepatic Metastases from Gastric Carcinoma

“Aprioristic passive attitude”: this is the mode that correctly defines the standard approach to gastric cancer patients presenting with hepatic metastases. This behaviour is deeply motivated by the aggressive biology of the disease that so often frustrates any therapeutic approach. In fact, at diagnosis liver metastases are often multiple and associated to other extra-hepatic metastatic sites [D’Angelica et al., 2004; Dicken et al., 2005]. Furthermore, in the rare cases submitted to ablative treatments, hepatic and systemic recurrence has been experienced in the majority of cases. However, considering survival performances extrapolated from a cohort of 1452 patients submitted to hepatic resection for noncolorectal nonendocrine liver metastases [Adam et al.,2006], it was observed that metastases from gastric adenocarcinoma performed in an intermediate way, ranking 10th in a list of 18 primaries. In fact, in selected cases an aggressive treatment can achieve unexpected results: 5-year survival rates from 10% to 40% have consistently been reported in surgical series considering patients with liver metastases as sole metastatic site. An aggressive attitude, however, doesn’t really penetrate into clinical practice and passivity still prevails, as depicted by an Italian survey reporting over 60% of patients not receiving specific treatments, including 30% of cases affected by 1 or 2 small metastases, and by therapeutic indication being influenced by patients’ determination [Tiberio et al., 2008]. This attitude is rather diffused if a recent review reported 436 surgically treated cases [Kerkar, 2010] and a French survey recruited 101 patients from 41 centres [Chiche, 2005], numbers to be faced, for example, to more than 14700 resections for metastases from colo-rectal cancer enrolled in LiverMetSurvey as to December 2010. With this contribution we will attempt to promote a pragmatic approach to these patients, knowing that only a ┤ετά┥οια (change of mind) may lead to the recognition of cases that can benefit from a tailored treatment and thus to better results. This attitude seems particularly important in these days in which promising therapeutic improvements are announced by state-of-art multimodal treatments favouring local and systemic control of the disease.