Two Cases of Gastric Cancer Forming Intra-portal Tumor Thrombosis

Yuichi Shimamoto¹⁾, Gen Tanabe¹⁾, Ryohei Ishibe¹⁾, Soji Sane¹⁾, Takeshi Shimizu²⁾, Takashi Aikou³⁾ and Ryuzo Sakata⁴⁾

¹⁾Division of Gastroenterology, Akune Citizen Hospital
²⁾Department of Pathology, Kagoshima-city Medical Association Hospital
³⁾First Department of Surgery, Kagoshima University, School of Medicine
⁴⁾Second Department of Surgery, Kagoshima University, School of Medicine

Gastric cancer forming a tumor thrombus in the portal system is rare and the implications of surgical resection are controversial. We report 2 such cases here. Case 1: A 58-year-old man suffering left flank pain was found in gastroscopy to have a "type 3" tumor in the lesser curvature from the middle to the lower gastric body. During surgery, we found a tumor thrombus from the left gastric vein to the portal vein, and conducted total gastrectomy with combined resection of the pancreas body, spleen and partial transverse colon, and removal of the tumor thrombus. He did not report any symptom during the 8 months following surgery, but died due to tumor thrombus recurrence in the portal vein 15 months after surgery. Case 2: A 74-year-old man suffering epigastralgia was found in endoscopic examination to have a "type 2" tumor in the middle gastric body. Preoperative ultrasonography, computed tomography, and angiography showed a tumor thrombus in the left portal vein, necessitating total gastrectomy with left hepatic lobectomy. Although the patient remained alive without any evidence of recurrence for 21 months, he died for metastasis to the liver 26 months after surgery.
In conclusion, we suggest that gastrectomy with removal of the portal tumor thrombus in gastric cancer is feasible in improving quality of life and prolonging survival.

Key words
gastric cancer, intra-portal tumor thrombosis, tumor thrombosis

Reprint requests
Yuichi Shimamoto Second Department of Surgery, Kagoshima University, School of Medicine 8-35-1 Sakuragaoka, Kagoshima city, 890-8520 JAPAN

Accepted
April 30, 2003

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