title: Resection of Large Metachronous Liver Metastasis with Gastric Origin: Case Report and Review of the Literature.
abstract: BACKGROUND
  Increasing evidence suggests that surgical resection may be offered to a subgroup of patients with liver metastasis of gastric adenocarcinoma. The aim of this case report is to illustrate the surgical resection of a single liver metachronous recurrence twelve months after a radical total gastrectomy for cancer.
  
  
  METHODS
  A 63-year-old male patient with an Eastern Cooperative Oncology Group performance status of 1 was referred to our hospital for a single, large liver metastasis, twelve months after a radical total gastrectomy and DII lymphadenectomy for upper third gastric adenocarcinoma. As the adjuvant treatment, the patient received 12 cycles of FOLFOX chemotherapy. During the present admission, the abdominal computed tomography (CT) revealed a single liver metastasis located in the segments 5 and 6, of 105/85 mm in diameter. Surgical resection by an open approach of liver metastasis was decided. We performed a non-anatomical liver resection, without inflow control due to significant peritoneal adhesions in the liver hilum secondary to the previous lymphadenectomy. The patient was discharged after seven days, with an uneventful recovery. Six months after the second surgical procedure, the patient developed a local liver recurrence. The surgical resection of the liver recurrence was performed, with no postoperative morbidities, and the patient was discharged after eight days. Three months after the latest surgery, the patient is under adjuvant chemotherapy, with no imagistic signs of further recurrences.
  
  
  CONCLUSIONS
  Hepatic resection for liver metastasis of gastric origin may offer satisfactory oncological outcomes in a very selected subgroup of patients.
authors.affiliation: General Surgery Department, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest.
authors.forename: Ionut
authors.initials: I
authors.lastname: Negoi
authors.affiliation: General Surgery Department, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest.
authors.forename: Alexandru
authors.initials: A
authors.lastname: Runcanu
authors.affiliation: General Surgery Department, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest.
authors.forename: Sorin
authors.initials: S
authors.lastname: Paun
authors.affiliation: Anatomy and Embryology Department, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest.
authors.forename: Ruxandra Irina
authors.initials: RI
authors.lastname: Negoi
authors.affiliation: General Surgery Department, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest.
authors.forename: Mircea
authors.initials: M
authors.lastname: Beuran
keywords: gastric cancer; liver metastases; metachronous resection; oligometastases