Umbilical Metastasis of the Gastric Cancer

Osamu Kobayashi, Takayuki Nakamura, Mitsunori Saito, Takaki Yoshikawa, Akira Tsuburaya, Motonori Sairenji and Hisahiko Motohashi

Third Department of Surgery, Kanagawa Cancer Center

We report a case with an umbilical metastasis of gastric cancer, referring to total of 7 cases during the past 10 years. The metastatic rate to the umbilicus was 0.34%in a total of 2,070 gastric cancer cases. Three were recurrent cases after curative gastrectomy, two were relapsed cases after non-curative gastrectomy, one was a case with synchronous metastasis, and the remaining patient had presented with the umbilical tumor prior to the diagnosis of gastric cancer. The recurrence rate was 1.7% among 174 recurrent cases. The primary tumors were stage III and IV, and all had lymph node metastasis. The intervals between gastrectomy and umbilical metastasis were between 7 and 53 months. The umbilical metastases were diagnosed by excisional biopsy in 5 cases and by cytology in 2 cases. All cases had peritoneal metastases in combination. The probable route of umbilical metastasis was direct in 2 cases, lymphatic in 3 cases, and hematological in 1 case. Treatment for the umbilical metastases consisted of resection followed by chemotherapy in 5 cases, resection alone in one case, and chemotherapy alone in one case. Survival time after the appearance of metastases in the patients who died was poor and ranged from 4 to 6 months. The outcome of patients with an umbilical metastasis was determined by peritoneal metastases. In order to decide proper treatments and prognosis, intraperitoneal examination by a laparoscopy provide useful information of the extent, location, and response to treatment of the tumor.

Key words
Sister Mary Joseph's nodule of gastric cancer, laparoscopy

Reprint requests
Osamu Kobayashi Third Department of Surgery, Kanagawa Cancer Center 1-1-2 Nakao, Asahi-ku, Yokohama, 241-0815 JAPAN

Accepted
May 23, 2000

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