[Resection of a synchronous liver metastasis from gastric cancer associated with portal vein tumor thrombosis - a case report].

The patient was a 71-year-old woman who was referred to our hospital with a diagnosis of gastric cancer. Computed tomography( CT) scans revealed a liver tumor, which we diagnosed as liver metastasis from the gastric cancer. A type 2 tumor was observed in the lesser curvature side of the gastric angle, and a huge tumor measuring 75 mm was seen in the lateral segment of the liver. A tumor thrombus from the metastatic lesion in the liver jutting out into the umbilical portion of the portal vein was observed. Measurement of tumor marker levels showed that the α-fetoprotein (AFP) level was slightly elevated at 20.7 ng/mL. Distal gastrectomy and resection of the left lobe of the liver were performed at surgery. The results of the pathological examination indicated a tub2, T3 (ss), N1, M1 (HEP), ly0, v2, stage IV gastric cancer with liver metastasis, and without AFP expression. The postoperative course was favorable, and the patient was treated in the outpatient clinic with postoperative adjuvant chemotherapy consisting of 80 mg of S-1. No adverse events were noted, and it was possible to complete 10 courses of chemotherapy. Because there was no evidence of recurrence, treatment was completed in 1 year and 2 months. No recurrence was observed until the third year after surgery. Consistent with a slight elevation in the tumor marker levels at 3 years and 6 months, recurrence was observed in the remnant liver. The patient died of her disease at 3 years and 10 months. Gastric cancers that give rise to portal vein tumor thrombosis are rare. Their outcome is generally poor, and early recurrence in the remnant liver is common. In the present case, R0 resection was possible because the liver metastasis was solitary and the tumor thrombosis was mild. To a certain extent, an improvement in the outcome was observed. However, the recurrence progressed rapidly, making it impossible to perform adequate treatment. More diligent examinations and continuation of long-term treatment might have been required to improve the patient's prognosis.