Gastric cancer with liver metastasis.

Surgical treatment of gastric cancer with liver metastasis (GCLM) is currently a frequent topic of discussion at professional surgical symposia. There is a low number of patients and a lack of large clinical multi-center studies describing the benefits of this treatment approach. The article describes a patient with GCLM, growing through stomach wall serosa, invading the spleen hilum, distal part of pancreas with metastasis to S7 of the right liver lobe. The patient had total gastrectomy performed with D2 lymphadenectomy, distal pancreatectomy with splenectomy, resection of diaphragm and RFA of the metastatic lesion in S7 of the liver. Post-surgery course was free of complications, followed by adjuvant chemotherapy. 2 years after the surgery, the patient is in full remission, free of any relapse. Liver resection or RFA is not commonly used in the gastric cancer with liver metastasis (GCLM). At present, there is no direct marker available to define the degree of biological aggressiveness of the tumor (indicating or contra-indicating the surgical treatment), therefore we are left to rely on indirect prognostic factors: cancer invasion in the gastric wall serosa, presence of 3 and more liver metastases, size of metastasis exceeding 50 mm (Fig. 2, Ref. 13).