[A case of surgical resection for liver metastasis of gastric cancer with portal vein tumor thrombus].
A 58-year-old man presented with anorexia and weight loss in April 2010. Endoscopic examination revealed a type 3 tumor extending from the gastric cardia to the antrum. Preoperative imaging showed liver metastasis (S8; 2 cm) and direct invasion of the cancer into the pancreas. We administered 4 courses of chemotherapy (DCS) for the unresectable tumor; the impact of the therapy was partial response (PR). We performed total gastrectomy, D2 dissection, splenectomy, distal pancreatectomy, and partial hepatectomy (S8) in April 2011. The patient was treated with 8 courses of adjuvant chemotherapy with S-1. In April 2012, abdominal computed tomography (CT) revealed a solitary recurrent lesion in the liver (S2). After 7 courses of chemotherapy(weekly paclitaxel), abdominal CT and magnetic resonance imaging (MRI) revealed a tumor thrombus in the portal vein extending from P2 to the umbilical portion (UP). We performed left hepatectomy and cholecystectomy due to the absence of new lesions. Histopathological findings revealed that the poorly differentiated adenocarcinoma had metastasized to the liver. Abdominal CT revealed the presence of multiple recurrent metastases in the liver, 4 months after the surgery. The patient died 27 months after the initial surgery and 7 months after the last operation.
Dept. of Gastroenterological Surgery, Graduate School of Medicine, Osaka University.
Tomoki
T
Hata
Hiroshi
H
Wada
Yoshito
Y
Tomimaru
Akira
A
Tomokuni
Naoki
N
Hama
Koichi
K
Kawamoto
Shogo
S
Kobayashi
Tadafumi
T
Asaoka
Shigeru
S
Marubashi
Hidetoshi
H
Eguchi
Koji
K
Umeshita
Shuji
S
Takiguchi
Masaki
M
Mori
Yuichiro
Y
Doki
Hiroaki
H
Nagano
D003131:Combined Modality Therapy; D004338:Drug Combinations; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010094:Oxonic Acid / Q000627:therapeutic use; D017239:Paclitaxel / Q000627:therapeutic use; D011169:Portal Vein / Q000473:pathology*; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D005641:Tegafur / Q000627:therapeutic use; D020246:Venous Thrombosis / Q000209:etiology / Q000601:surgery*
D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D017239:Paclitaxel