A Gastric Cancer Patient with Metastases in the Liver and Para-aortic Lymph Nodes Who Survived for 5 Years with Postoperative Adjuvant Immunochemotherapy

Kazuo Hirose, Makoto Ishida, Kunihiro Fujita, Hiroyuki Maeda, Takanori Goi, Atsushi Iida, Kanji Katayama, Akio Yamaguchi and Gizo Nakagawara^*

First Department of Surgery, School of Medicine, Fukui Medical University, Tsuruga Municipal Hospital^*

A 72-year-old man who exhibited Borrmann type 2 gastric cancer with metastases in the liver and para-aortic lymph nodes underwent total gastrectomy with D4 lymph node dissection, distal pancreaticosplenectomy, and partial resection of the two metastatic liver tumors. The para-aortic nodal metastases were not completely dissected, and resulted in noncurative resection. However, a catheter for hepatic arterial infusion was inserted. The resected cancer was histologically diagnosed as poorly differentiated adenocarcinoma, ssγ , ly3, v1, and n4. For early postoperative chemotherapy, the patient was treated with hepatic arterial infusion (750 mg of 5-FU, 10 mg of adriamycin, and 26 mg of mitomycin C), oral doxifluridine (600 mg/day), and intravenous infusion of cisplatin (100 mg), mitomycin C (48 mg), etoposide (150 mg) and pirarubicin (60 mg). Administrations of oral tegafur (600 mg/day) and intravenous lentinan (2 mg/2 weeks) were continued at an outpatient clinic. At 1 year and 6 months after the operation, residual metastases in the para-aortic lymph node were not detected by abdominal computed tomography, and complete response continued for 5 months. Therafter, the tegafur-lentinan therapy was continued, the patient remained in good general condition, and the values of both carcinoembryonic antigen and immunosuppressive acidic protein in the serum normal until 4 years and 6 months after the operation. He died of mediastinal lymph node recurrence 5 years and 2 months after the operation, but no hepatic recurrence was detected. Thus, the patient was successfully treated by the maintaining immunochemotherapy, as well as cytoreductive surgery and early postoperative induction chemotherapy, which resulted in long-term survival.

Key words
gastric cancer, liver metastasis, para-aortic lymph node metastasis

Reprint requests
Kazuo Hirose The First Department of Surgery, School of Medicine, Fukui Medical University 23-3 Shimoaizuki, Matsuoka-machi, Yoshida-gun, Fukui, 910-1193 JAPAN

Accepted
July 28, 1999

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