Synchronous Right Trisegmentectomy and Gastrectomy for Huge Hepatic Metastasis as First Manifestation of Advanced Gastric Cancer

摘要

In a series of 4370 patients with gastric cancer, 5 per cent developed liver metastasis (synchronous and metachronous); among this group, only 10 per cent were resectable.2 Hepatic resection has been reported as effective therapy for metastatic colorectal cancer3 with a 5-year survival rate from 30 to 50 per cent.4 On the contrary, in the case of liver metastases for gastric cancer, also in the absence of incurable factors, the effectiveness of hepatic resection is still widely debatable because of the presence of the multiple bilobar metastases with a 5-year survival rate from 0 to 38 per cent.2-4 In the last years, many studies have reported a small select number of cases with long-term survival (3 to 17 years) after surgical treatment of synchronous and metachronous liver metastases from gastric cancer.1-4 The authors that reported cases of gastric cancer with synchronous liver metastases (as we showed in our article) recorded a long survival rate after hepatic curative resection for patients with an early gastric lesion or single liver metastases from 1.5 to 1.7 cm in maximum diameter.1 Moreover, some authors showed a 17-year survival rate after curative gastric and hepatic resection in a patient with single liver metastases 2 to 5 cm in diameter.4 The authors performed limited hepatic resection because of the number (solitary liver metastases) and the dimension of the lesion; they also reported cases with repeated hepatic resection that were disease-free at 5-year follow up.4 A multivariate analysis from Ueada et al. demonstrated that an RO minor liver resection for solitary and small (1.5 to 2.5 cm) repetitive lesions are independent prognostic factors in the surgical treatment for synchronous liver metastases from gastric cancer. 1 In another study, Sakamoto et al. found at multivariate analysis that the number (solitary or multiple) of hepatic lesions and the maximum tumor size (less than 5 cm or larger) were independent prognostic factors.2 In our case, the primitive gastric lesion was not an early tumor (pT2b) with pNO and the two synchronous hepatic lesions were 16 and 20 cm.