A Case of Advanced Gastric Cancer with Liver Metastasis Resected following Combined TS-1 and CPT-11 Neoadjuvant Chemotherapy

Tomoyoshi Takayama, Mitsutoshi Tatsumi, Kiyoshi Kamada, Jyunji Okayama, Hisanori Kashizuka, Hiroyuki Kuge, Takeshi Ueda, Takahito Nakamura*, Hiroshi Maruyama** and Shinsaku Kimura***

Department of Surgery, Department of Internal Medicine*, Department of Pathology** and Department of Pharmacy***, Hoshigaoka Koseinenkin Hospital

A 63-year-old man was admitted for upper abdominal pain was found in endoscopic examination to have type 3 advanced gastric cancer in the lower stomach. Abdominal computed tomography and ultrasonography showed solitary 30 mm liver metastasis in liver segment S4. We started neoadjuvant chemotherapy using TS-1 plus CPT-11. TS-1 (100 mg/body weight/day) was orally administered for 3 weeks followed by a drug-free 2-week period, and CPT-11 (80 mg/body weight) was administered intravenously on day 1 and 15 as 1 course. After 2 courses of chemotherapy, the liver metastasis shrank. Subsequent laparotomy found no liver metastasis in intraoperative ultrasonography, so we conducted distal gastrectomy with D2 lymph node cleaning, reconstruction by R-Y anastomosis, and cholecystectomy. TS-1 alone was continued for a year as adjuvant chemotherapy. No recurrence was seen in the 3 years after surgery. Initial treatment for advanced gastric cancer with resectable synchronous liver metastasis is generally surgery, but we conducted surgical treatment after neoadjuvant chemotherapy. This case suggests that neoadjuvant chemotherapy is effective against advanced gastric cancer with liver metastasis.

Key words
gastric cancer, liver metastasis, neoadjuvant chemotherapy

Reprint requests
Tomoyoshi Takayama Department of Surgery, Hoshigaoka Koseinenkin Hospital
4-8-1 Hoshigaoka, Hirakata, 573-0013 JAPAN

Accepted
September 26, 2007

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