1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer
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2. Ajani JA, Bentrem DJ, Besh S, D'Amico TA, Das P,
Denlinger C, Fakih MG, Fuchs CS, Gerdes H, Glasgow
RE, Hayman JA, Hofstetter WL, Ilson DH, Keswani RN,
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Mulcahy MF, Orringer MB, Posey JA, Sasson AR, Scott
WJ, Strong VE, Varghese TK Jr, Warren G, Washington
MK, Willett C, Wright CD, McMillian NR, Sundar H.
Gastric cancer, version 2.2013: featured updates to the
NCCN Guidelines. J Natl Compr Canc Netw 2013; 11(5):
531-46.
3. Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A,
Fleig WE. Chemotherapy in advanced gastric cancer: A
systematic review and meta-analysis based on aggregate
data. J Clin Oncol 2006; 24(18): 2903-9.
4. Choi IS, Oh DY, Kim BS, Lee KW, Kim JH, Lee JS.
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DISCUSSION
Although some authors have suggested that MGC represents
a systemic disease and surgery has no role in its treatment, a
considerable proportion of patients have been found to have
a better disease-free survival longer than 5 years following
liver resection (8). Many factors such as histology, invasion
depth, venous invasion for and size of metastasis, time of
liver resection and surgical margins may be related with
the outcomes following liver metastasectomy for patients
with gastric cancer metastasis. (9). Liver metastasectomy
from gastric cancer is rarely indicated. Multiple lobe
metastases, peritoneal involvement and widespread lymph
node metastases or direct invasion to other organs remain
a therapeutic challenge for liver resection (10). In Japan,
D2 lymph node dissection is recommended for advanced
gastric cancer (11); however, this procedure might not have
been performed by surgeons as patients have extensive or
critical comorbidity. In contrary to the literature, our case
had lots of different poor prognostic factors such as neural/
lymphovascular invasion, peripheral tissue invasion, lymph
node invasion and size of tumor. However, our patient had
longer disease-free survival.
CONCLUSION
Gastric cancer remains a formidable challenge due to
high-risk cancer biology and the complex operative and
multidisciplinary therapy requirements. Best curative and
palliative intent treatment requires balancing surgical
treatment with other modality options. R0 resection and
extended lymphadenectomy are the operative components
with the greatest curative impact. In addition, alternative
treatment options such as metastasectomy and cytoreductive
surgery should be tried for suitable patients.
Conflict of Interest
None of the authors of this paper has a financial or personal
relationship with other people or organizations that could
inappropriately influence or bias the content of the paper.
reports in the literature about better survival following
liver metastasectomy (5). In fact, a number of studies
have demonstrated that the effects and advantages of liver
metastasectomy in gastric hepatic metastases are uncertain
(6). Most patients with gastric cancer accompanying liver
metastasis are not candidate for potential curative surgery
due to the presence of synchronous distant extrahepatic or
locally advanced disease (7). Herein we aimed to emphasize
the importance of surgical excision in a patient with gastric
cancer who underwent surgery for D2 dissection and liver
metastasectomy at the time of diagnosis.
CASE
A 51 year-old-male patient presented to the hospital with
dyspeptic complaints approximately three years ago.
Upper system endoscopy revealed an ulcero-vegetant
mass lesion extending from the cardia to the corpus.
Pathological examination identified a well-differentiated
adenocarcinoma of the stomach. No distant metastases
were present on screening. During intraoperative surgery
a mass 5x8 cm in size and invading the transverse colon
and pancreas and another metastatic mass in segment 7
of the liver were observed. Total gastrectomy + retrocolic
ROUX-Y esophagojejunostomy + distal pancreatectomy
+ omentectomy + retroperitoneal lymph node dissection
+ D2 lymph node dissection + splenectomy + transverse
colon segmental resection + endwise colo-colostomy and
liver metastasectomy were performed for the patient.
Pathology results were compatible with a well-differentiated
adenocarcinoma with neural/lymphovascular invasion
and negative tumor margins for gastric mass and
metastatic carcinoma for hepatic mass. Staging was
T3N2M1 according to AJCC 2010. The patient received
6 cycles of chemotherapy with ECF (epirubicin, cisplatin,
5-fluorouracil) as adjuvant treatment. After 3 years of
follow up without progression, the patient presented with
metastatic liver and lung masses. The FOLFIRI (folinic
acid, 5-fluorouracil, irinotecan) chemotherapy scheme was
planned as second line treatment.
51
Three-Year Disease-Free Survival After D2 Dissection and Liver Metastasectomy in a Gastric Cancer
Akd Tıp D / Akd Med J / 2017; 1: 49-51
5. Kodera Y, Fujitani K, Fukushima N, Ito S, Muro K,
Ohashi N, Yoshikawa T, Kobayashi D, Tanaka C,
Fujiwara M. Surgical resection of hepatic metastasis from
gastric cancer: A review and new recommendation in
the Japanese gastric cancer treatment guidelines. Gastric
Cancer 2014;17(2): 206-12.
6. Ambiru S, Miyazaki M, Ito H, Nakagawa K, Shimizu H,
Yoshidome H, Shimizu Y, Nakajima N. Benefits and limits
of hepatic resection for gastric metastases. Am J Surg
2001; 181(3): 279-83.
7. Ueda K, Iwahashi M, Nakamori M, Nakamura M,
Naka T, Ishida K, Ojima T, Yamaue H. Analysis of the
prognostic factors and evaluation of surgical treatment
for synchronous liver metastases from gastric cancer.
Langenbecks Arch Surg 2009; 394(4): 647-53.
8. Garancini M, Uggeri F, Degrate L, Nespoli L, Gianotti
L, Nespoli A, Uggeri F, Romano F. Surgical treatment of
liver metastases of gastric cancer: Is local treatment in a
systemic disease worthwhile? HPB (Oxford) 2012; 14(3):
209-15.
9. Tsujimoto H, Ichikura T, Ono S, Sugasawa H, Hiraki S,
Sakamoto N, Yaguchi Y, Hatsuse K, Yamamoto J, Hase
K. Outcomes for patients following hepatic resection of
metastatic tumors from gastric cancer. Hepatol Int 2010;
4(1): 406-13.
10. Maehara Y, Moriguchi S, Kakeji Y, Kohnoe S, Korenaga
D, Haraguchi M, Sugimachi K. Pertinent risk factors and
gastric carcinoma with synchronous peritoneal dissemination
or liver metastasis. Surgery 1991; 110(5): 820-3.
11. Nakajima T. Gastric cancer treatment guidelines in Japan.
Gastric Cancer 2002; 5(1): 1-5
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