Long-term Survival of a Patient with Multiple Liver Metastases and Peritoneal Dissemination from Small Bowel Cancer by Postoperative Chemotherapy

Abstract

A 73-year-old man diagnosed as having ileus who presented with nausea and vomiting was referred to our hospital. Abdominal contrast-enhanced computed tomography revealed a thickening of the small intestinal wall, swelling of surrounding mesenteric lymph nodes, and multiple liver metastases. Double-balloon endoscopy revealed a type 2 total circumference lesion in the jejunum, on the immediate anal side from the Treitz ligament, and laparotomy was performed. The primary tumor, which was 70 mm in diameter, was located in the ileum, 20 cm from the Treitz ligament on the anal side, and liver metastasis and numerous disseminated nodules were confirmed in the peritoneal cavity. We performed partial intestinal resection and obtained biopsies of samples from the hepatic and peritoneal nodules. The histopathological diagnosis was mucinous adenocarcinoma in all the specimens. Postoperative chemotherapy with S-1 + CDDP was started. Treatment response was judged as partial response on CT examination at 6 months and as complete response at 36 months after the surgery. From the 45th month after surgery, treatment was continued with S-1 alone. Thereafter, chemotherapy was terminated 78 months after the operation without findings of recurrence. Currently, 10 years have passed since the surgery, without apparent findings of recurrence.