J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 11, Number 8, August 2019, pages 600-608

Gastrectomy Alone or in Combination With Hepatic Resection in the Management of Liver Metastases From Gastric Cancer: A Systematic Review Using an Updated and Cumulative Meta-Analysis

Figures

Figure 1. Flow diagram of the search strategy.

Figure 2. a) Traditional meta-analysis of synchronous/metachronous metastases demonstrates that significantly less metachronous metastases were included compared to synchronous metastases. b) Cumulative meta-analysis of synchronous/metachronous metastases depicts two time periods, one from 1994 to 2014 when nonsignificant differences were demonstrated and a second from 2015 until present when it was demonstrated that significantly less metachronous metastases compared to synchronous cases were included.

Figure 3. a) Traditional meta-analysis of solitary/multiple metastases demonstrates that significantly less multiple metastases were included compared to solitary metastases. b) Cumulative meta-analysis of solitary/multiple metastases depicts two time periods, one from 1994 to 2003 when nonsignificant differences were demonstrated and a second from 2003 until present when it was demonstrated that significantly less multiple metastases compared to solitary cases were included.

Figure 4. Forest plot depicting 1-, 2-, 3-, 5-year overall survival of gastrectomy plus hepatectomy versus gastrectomy alone. It is depicting that the gastrectomy plus hepatic resection cohort demonstrated significantly better survival benefits compared to gastrectomy alone.

Table

**Table 1.** Outcomes of Interest
Outcome of interest	Number of studies and patients (%; events/total)	Statistical method, estimated effect, 95% CI	P value	I² (%)
OS: overall survival; MD: mean difference; HR: hazard ratio; OR: odds ratios.
Age	4, 244	MD = -2.40 (-6.13 to 1.34)	0.23	57
Synchronous metastases	4, 206 (54%; 56/104) (51%; 52/102)	OR = 0.42 (0.02 to 8.50)	0.57	89
Metachronous metastases	4, 206 (28%; 29/104) (29%; 30/102)	OR = 1.72 (0.86 to 3.43)	0.12	85
Unilobar metastases	6, 430 (58%; 92/159) (25%; 67/271)	OR = 3.88 (2.43 to 6.19)	< 0.001	0
Bilobar metastases	6, 430 (26%; 41/159) (49%; 133/271)	OR = 0.27 (0.08 to 0.91)	0.04	83
Solitary metastases	5, 320 (52%; 64/124) (36%; 71/196)	OR = 2.98 (0.95 to 9.37)	0.06	70
Multiple metastases	5, 320 (33%; 41/124) (66%; 129/196)	OR = 0.17 (0.04 to 0.80)	0.02	83
1-year OS	9, 637	HR = 0.52 (0.39 to 0.69)	< 0.001	39
2-year OS	4, 397	HR = 0.85 (0.74 to 0.97)	0.01	44
3-year OS	9, 637	HR = 0.80 (0.72 to 0.90)	0.003	58
5-year OS	7, 452	HR = 0.83 (0.78 to 0.90)	< 0.001	0
Subgroup analysis East versus West
1-year OS East	6, 306	HR = 0.42 (0.28 to 0.65)	< 0.001	34
1-year OS West	3, 331	HR = 0.63 (0.43 to 0.91)	0.01	47
2-year OS West	3, 331	HR = 0.85 (0.71 to 1.01)	0.07	53
2-year OS East	1, 66	HR = 0.80 (0.65 to 1.00)	0.05	0
3-year OS East	6, 306	HR = 0.78 (0.70 to 0.86)	< 0.001	0
3-year OS West	3, 331	HR = 0.85 (0.69 to 1.05)	0.13	67
5-year OS East	5, 272	HR = 0.84 (0.78 to 0.91)	< 0.001	5
5-year OS West	2, 180	HR = 0.80 (0.68 to 0.94)	0.008	0