Long-term prognosis and postoperative liver atrophy after gastrectomy in patients with gastric cancer and liver cirrhosis

PURPOSE: Gastrectomy in patients with liver cirrhosis is associated with an increased postoperative risk and poor prognosis; however, the long-term outcomes remain unclear. This study evaluated the survival of patients with cirrhosis after gastrectomy, focusing on postoperative nutritional deterioration and time-dependent survival effects. METHODS: This retrospective study included 847 patients who underwent gastrectomy for gastric cancer. Patients were categorized into liver cirrhosis (LC) and non-LC groups. One-to-four propensity score matching was performed to adjust for the baseline characteristics. Overall survival, cancer-specific survival, and postoperative liver volume changes were compared between the two groups. The time-dependent effects were examined using a piecewise-constant hazard model. RESULTS: After matching, overall survival was significantly worse in the LC group, whereas the cancer-specific survival did not differ between the groups. The survival disadvantage was most pronounced within the first postoperative year. An exploratory analysis demonstrated significant postoperative hepatic atrophy in patients with cirrhosis. Liver disease-related mortality, including hepatic failure and hepatocellular carcinoma, was significantly higher in the LC group. CONCLUSIONS: Gastrectomy in patients with liver cirrhosis was associated with a worse overall survival, primarily because of liver disease-related mortality, whereas cancer-specific survival was comparable to that in patients without cirrhosis. A greater postoperative liver volume reduction has been observed in the patients with cirrhosis, although its mechanism and clinical significance remain unclear. Further prospective studies are warranted to determine whether nutritional or other perioperative interventions improve the postoperative outcomes.