Nakamichi Naosuke, Tsujiura Masahiro, Matsui Tomohiro, Yamamoto Taiga, Yoshioka Ayana, Hiramoto Hidekazu, Ouchi Yoshimi, Ishimoto Takeshi, Kosuga Toshiyuki, Mochizuki Satoshi, Nakashima Susumu, Bamba Masamichi, Masuyama Mamoru, Otsuji Eigo
Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan.
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan.
Surg Case Rep. 2021 Jan 6;7(1):6. doi: 10.1186/s40792-020-00979-7.
The indication of surgical resection for liver metastasis from gastric cancer (GC) is still limited and controversial because of its more aggressive oncological characteristics than liver metastasis from colorectal cancer. Pyloric stenosis causes an inadequate oral intake and malnutrition in GC patients. We herein report a case of GC with these two factors that was successfully treated by the combination of gastro-jejunal bypass and chemotherapy, followed by curative R0 resection.
A 60-year-old man was diagnosed with type 2 GC with liver metastasis and pyloric stenosis, which was confirmed as the HER2-positive type. He underwent gastrojejunostomy and received capecitabine and cisplatin (XP) + trastuzumab chemotherapy. After three courses of the XP + trastuzumab regimen, shrinkage of the primary lesion and liver metastasis was confirmed and his nutritional parameters markedly improved with a stable oral intake after bypass surgery. He underwent curative R0 resection by distal gastrectomy with D2 lymphadenectomy and partial hepatectomy. Histologically, viable tumor cells were observed in less than one-third of the primary lesion, and only scar tissue without viable cancer cells was noted in the resected liver specimen. His postoperative course was uneventful, and recurrence has not been detected in the 30 months after surgery without adjuvant chemotherapy.
The present case report describes a successful strategy for advanced GC with pyloric stenosis and liver metastasis.
由于胃癌肝转移比结直肠癌肝转移具有更强的肿瘤学侵袭性，其手术切除的适应证仍然有限且存在争议。幽门狭窄会导致胃癌患者经口摄入量不足和营养不良。我们在此报告一例同时存在这两个因素的胃癌病例，该病例通过胃空肠吻合术和化疗联合治疗，随后进行了根治性R0切除，治疗成功。
一名60岁男性被诊断为2型胃癌伴肝转移和幽门狭窄，确诊为HER2阳性型。他接受了胃空肠吻合术，并接受了卡培他滨和顺铂（XP）+曲妥珠单抗化疗。在接受三个疗程的XP+曲妥珠单抗治疗方案后，原发灶和肝转移灶缩小得到确认，并且在旁路手术后他的营养参数显著改善，经口摄入量稳定。他接受了远端胃切除术加D2淋巴结清扫和部分肝切除术的根治性R0切除。组织学检查显示，原发灶中存活肿瘤细胞少于三分之一，切除的肝脏标本中仅见无存活癌细胞的瘢痕组织。他术后恢复顺利，在未接受辅助化疗的情况下，术后30个月未检测到复发。
本病例报告描述了一种针对晚期胃癌伴幽门狭窄和肝转移的成功治疗策略。
