Source:Current Problems in Cancer
Author(s): Beata Polkowska-Pruszyńska, Karol Rawicz-Pruszyński, Bogumiła Ciseł, Robert Sitarz, Grażyna Polkowska, Witold Krupski, Wojciech P. Polkowski
Gastric carcinoma (GC) is the fifth most common malignancy worldwide but the third leading cause of cancer death, and surgery remains the only curative treatment option. Prognosis of patients with liver metastases from gastric carcinoma (LMGC) is poor, and the optimal treatment of metastatic gastric cancer remains a matter of debate. In 2002 a 53-year-old male patient with GC and synchronous oligometastatic lesion in liver VIII segment underwent a total gastrectomy combined with metastasectomy. The pathological diagnosis was stage IV gastric adenocarcinoma (pT3N2M1), which was treated with adjuvant chemotherapy (PELF). In 2012 abdominal ultrasound and percutaneous liver biopsy revealed recurrence of the metastasis in the right liver lobe. Progression of the disease was observed after palliative chemotherapy (EOX). Nevertheless an extended right-hemihepatectomy, with excision of segments 1, 4A, 5, 6, 7 and 8, was still performed. Pathological examination confirmed large KRAS-, and HER2-negative LMGC. The patient is alive and free of disease 47 months after the repeated hepatectomy, and 13 years after removal of the primary GC and synchronous liver metastasis. Based on review of 27 articles, 5-year OS rate following gastrectomy and liver metastasectomy may reach 60%, with median survival time up to 74 months. Although the combination of aggressive surgical approach with systemic therapy for LMGC is controversial, it may allow favourable outcome. Careful selection of patients based on evaluable predictive factors for R0 surgical resection of both, primary tumour and liver metastases can lead to cure, as shown in our case presentation, where 10 year relapse-free survival was observed, followed by successful repeated hepatectomy due to liver metastases.
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