Tomáš Šálek
Management of patients with hepatic metastases as the sole metastatic site at diagnosis of gastric cancer (synchronous setting) or detected during follow-up (metachronous) is controversial. The prevailing attitude in these cases is passive, leading to chemotherapy and surgical palliation. In fact, in an adequately selected subgroup of patients, the surgery, especially if integrated into multimodal therapeutic strategies, may achieve unexpected 5-year survival rates, ranging from 10% to 40%. The critical revision of the literature suggests that some simple clinical criteria exist that may be effectively employed in patient’s selection. These are mainly related to gastric cancer (factors T, N, G) and the extent of hepatic involvement (factor H). Upon these criteria, it is possible to select about 50% of cases adequately. In the remaining 50% of cases, a critical discussion on a case-by-case basis is recommended, taking into consideration, that survival is strictly influenced by the ablation of the tumour bulk and multimodality treatments, including chemotherapy.