Long-Term Recurrence-Free Survival After Metachronous Surgery of the Stomach and Liver for Gastric Adenocarcinoma and Multiple, Synchronous Liver Metastases: A Case Report and Review of Literature

Abstract

This report describes a 58-year-old woman with gastric adenocarcinoma and liver metastases, who survives for more than 18 years after diagnosis. At diagnosis and first surgery, a moderately differentiated gastric adenocarcinoma with subserosal invasion was detected, along with 2 regional lymph node metastases and 2 liver metastases. She underwent gastrectomy and regional lymph node dissection but did not undergo liver operation then. After gastrectomy, she received adjuvant chemotherapy for 1 month but discontinued it due to severe diarrhea. Another metastasis in another area of the liver was detected, for which she underwent excision of the right lobe of the liver (subsegments 5, 6, and 7) about 30 months later. No signs of recurrence have been detected for 18 years (as of March 2012). This patient represents a rare case of long-term survival of gastric adenocarcinoma without recurrence after surgical treatment, despite multiple, synchronous, liver and regional lymph node metastases.Key words: Gastric cancer -Liver metastasis -Long-term survivor -Surgical resection T he prognosis for gastric adenocarcinoma with metastasis in the liver is poor, the duration of survival for most patients is quite limited, and there are few curative treatment options. However, there have been a few reports of long-term survival in patients who were surgically treated with complete Case ReportA 58-year-old woman was diagnosed with gastric adenocarcinoma during medical examination at another institution and was subsequently transferred to our hospital. Upper gastrointestinal series, endoscopy, biopsy, computed tomography (CT) scan, and abdominal ultrasonography (US) were performed, which demonstrated gastric adenocarcinoma with 2 metastatic lesions in subsegment 5 of the liver (Fig. 1a). Both the serum carcinoembryonic antigen (CEA) and the carbohydrate antigen 19-9 (CA 19-9) levels were within the normal range. On June 11, 1993, she underwent gastrectomy accompanied by regional lymph node dissection; however, surgery on the liver was not performed. Her postoperative course was uneventful. Macroscopic findings showed advanced gastric cancer type 3, where a part of the surrounding wall was not sharply defined (Fig. 1b). Pathologic findings showed moderately differentiated adenocarcinoma invading into the subserosal layer of the gastric wall ( Fig. 2a) and invading both lymphatic vessels (Fig. 2b) and veins ( Fig. 2c), as well as metastases to 2 infra-pyloric lymph nodes (Fig. 2d). As postoperative adjuvant chemotherapy, the anticancer drug Mitomycin C (20 mg) was administered intravenously on the day of surgery, and 20 mg/d UFT (Tegafur 800 mg þ uracil 1792 mg) was administered orally starting on June 22. However, the administration of adjuvant chemotherapy was discontinued in July due to the development of diarrhea caused by drug toxicity. After discontinuation of adjuvant chemotherapy, the patient underwent abdominal US, abdominal CT scan, and measurement of serum levels of CEA and CA19-9 every 3 to 6 months. Beginning in Decembe...

Effect of multimodal chemotherapy on survival of gastric cancer with liver metastasis – a population based analysis

“…The 5ySR of patients with LMGC in our study is much lower than that observed in previous studies examining LMGC patients from Beijing or Japan (9.2%, 12.2%, and 31.1%, respectively) (25,26). Several reports, including ours, have demonstrated that old age, Lauren classification, submucosal invasion, vascular involvement, lymph node metastasis, tumour differentiation, the number of LMs, and tumour size are significant factors influencing the prognosis of patients with LMGC (27)(28)(29)(30). In the present study, we also identified POCT and palliative chemotherapy as independent prognostic factors for patients with LMGC.…”

<p>Treatment of Synchronous Liver Metastases from Gastric Cancer: A Single-Center Study</p>

“…Current studies suggest that lymph node metastasis, differentiation, size and the number of liver metastases may be the main factors influencing the prognosis of patients with LMGC. 17 , 18 Liu et al retrospectively analyzed the clinicopathological data of 37 patients with LMGC who underwent surgical resection, and found a 5-year survival rate reaching 50% in patients without lymph node metastasis, which was significantly better than those with lymph node metastasis. 19 The degree of liver metastasis determines whether R0 resection could be obtained after surgery, thereby constituting the main prognostic factor in LMGC.…”