To investigate the prognostic status and influencing factors of radical and palliative surgery in patients with initial resectable gastric cancer with liver metastasis (GCLM).

A total of 150 patients with initially resectable GCLM admitted to Gong'an Hospital of Traditional Chinese Medicine Affiliated to Hubei University of Chinese Medicine from January 2021 to December 2024 were selected as the study objects, and the patients were divided into radical treatment group (n=89) and palliative group (n=61) according to surgical treatment methods. The prognosis and postoperative complications of the two groups of patients were compared. The survival curves were plotted using the Kaplan-Meier method, and the effects of different treatment regimens on the survival rate of patients with initially resectable GCLM were analyzed by the Log-rank test. Univariate and multivariate analyses were used to explore the factors influencing prognosis.

The median overall survival for the curative group was 32.6 months, with 1-year and 3-year survival rates of 84.3% and 44.9%, respectively. For the palliative group, the median overall survival was 18.4 months, with 1-year and 3-year survival rates of 62.2% and 21.3% (P<0.05). Among 150 patients with initially resectable GCLM, the favorable prognosis group included those who underwent complete surgical resection with few liver metastases, effective postoperative adjuvant therapy, and lower levels of biomarkers. The unfavorable prognosis group included patients with multiple liver metastases, those who could not undergo complete resection, those with postoperative recurrence or metastasis, poor chemotherapy response, and elevated biomarker levels. Among the 150 cases, 60 had a good prognosis and 90 had a poor prognosis. Comparisons of age, gender, smoking history, alcohol history, primary gastric tumor location, maximum diameter of the primary gastric tumor, WHO classification, number of liver metastases, liver metastasis distribution, and maximum diameter of liver metastases between the two groups showed no statistically significant differences (P>0.05). The favorable prognosis group had higher proportions of tumors with moderate to high differentiation and curative surgeries than the unfavorable prognosis group. Additionally, the number of metastatic lesions, abdominal metastasis, and vascular invasion were significantly lower in the favorable prognosis group compared to the unfavorable prognosis group (P<0.05). Logistic regression analysis showed that poorly differentiated tumors, multiple liver metastases, abdominal metastasis, and vascular invasion were risk factors affecting the prognosis of initially resectable GCLM patients undergoing curative and palliative surgical treatments, with curative surgery being a protective factor for prognosis (P<0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (χ²=0.180, P=0.672).

For initially resectable GCLM, radical surgical treatment can significantly prolong survival, but high-risk patients with a large number of liver metastases, peritoneal metastasis or vascular invasion should be strictly excluded.