J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 2723KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 104(10): 711-716, 2003

Feature topic

MANAGEMENT OF PATIENTS WITH HEPATIC METASTASES FROM GASTRIC CARCINOMA

1) Department of Surgery, ltami Municipal Hospital, Hyogo, Japan
2) Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

Masahiro Hiratsukai1), Tokiharu Yano1), Masayuki Yamamoto1), Makoto Okazaki1), Ikuo Kokufu1), Hideyuki Miyoshi1), Fumihiko Kimura1), Tomonori Tanei1), Kenji Umemoto1), Isao Miyashiro2), Yo Sasaki2), Osamu Ishikawa2)

Many studies have reported the benefit of hepatic resection for metastatic tumors from colorectal cancer. However, the significance of hepatic resection for gastric metastasis has been controversial. Peritoneal metastases were recognized in 40% of gastric cancer patients with liver metastases, and metastatic lesions in both lobes of the Iiver were seen in 60% of patients. Resection with curability B was performed in only 10% of the all gastric cancer patients with liver metastases. However, the overall 5-year survival rate of curability B resection was more than 30%, suggesting that it is worth while treating metastases of gastric cancer to the liver. Both synchronous and metachronous metastases are indications for hepatectomy. If there is only one liver metastasis, with no peritoneal and paraaortic lymph node metastases, curability B resection can be performed.
Although there is no consensus on the method of hepatectomy, wedge resection is satisfactory. As systemic chemotherapy, S-1+cisplatin results in a response rate of 50% in patients with matastases to the liver. As arterial infusion chemotherapy, the 5-fluorouracil-doxorubicin-mitomycin (FAM) regimen yields a response rate of more than 70% including 15% complete response rate. FAM is thus a superior resimen, but care must be taken to prevent complications resulting from intraarterial infusion of outside the vas due to deviation of the catheter.

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