2018 Volume 43 Issue 6 Pages 1042-1047
A 61-year-old man was referred to our hospital because of an elevated serum level of carcinoembryonic antigen. Esophagogastroduodenoscopy revealed a type 3 tumor in the prepyloric region, which was confirmed by biopsy as a well-differentiated tubular adenocarcinoma. Enhanced abdominal CT showed multiple metastatic lesions in both lobes of the liver. The gastric cancer was categorized as cT2(SS), cN1, cH1, cP0, cM0, c Stage Ⅳ, according to the Japanese classification of gastric carcinoma (13th edition). Remarkably, after eight courses of chemotherapy with S-1, the primary gastric cancer diminished in size, and the liver metastases disappeared. Thereafter, distal gastrectomy with D2 lymph node dissection and partial resection of two hepatic lesions were performed. Pathologically, the tumor was diagnosed as pT2(SS), pN1, pH0, sM0, f Stage Ⅱ gastric cancer, and the tumor response according to histological evaluation was Grade 1b. Postoperatively, the patient received oral tegafur/uracil and hepatic artery infusion chemotherapy with fluorouracil for a year. At present, 122 months since the surgery, the patient remains in good health and has shown no evidence of relapse. Although simultaneous multiple metastases from gastric cancer are associated with a poor prognosis, this patient was successfully treated by multidisciplinary therapy.
