Successful management of multiple liver metastasis from gastric cancer with second conversion surgery: A case report

Saki Sato; Kazuaki Tanabe; Hiroshi Ota; Yoshihiro Saeki; Hideki Ohdan

doi:10.1016/j.ijscr.2023.108340

Successful management of multiple liver metastasis from gastric cancer with second conversion surgery: A case report

Int J Surg Case Rep. 2023 Jun:107:108340. doi: 10.1016/j.ijscr.2023.108340. Epub 2023 May 19.

Authors

Saki Sato¹, Kazuaki Tanabe², Hiroshi Ota³, Yoshihiro Saeki¹, Hideki Ohdan⁴

Affiliations

¹ Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima 734-8551, Japan.
² Department of Perioperative and Clitical Care Management Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima 734-8551, Japan. Electronic address: Ktanabe2@hiroshima-u.ac.jp.
³ Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima 734-8551, Japan. Electronic address: hiota74@hiroshima-u.ac.up.
⁴ Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima 734-8551, Japan. Electronic address: hohdan@hiroshima-u.ac.jp.

Abstract

Introduction: Most conversion surgeries for patients with stageIV gastric cancer are performed on patients who have responded to first-line chemotherapy. Although conversion surgery after third-line chemotherapy with nivolumab has been reported, there are no cases wherein second conversion surgery was performed after third-line chemotherapy with nivolumab.

Presentation of case: A 72-year-old man presented with gastric cancer and an enlarged regional lymph node, and early esophageal cancer was identified after endoscopic submucosal dissection. After S-1 plus oxaliplatin as first-line chemotherapy, staging laparoscopy was performed, and liver metastasis was confirmed. The patient underwent a total gastrectomy with D2 lymphadenectomy, hepatic left lateral segmentectomy, and partial hepatectomy. One year after conversion surgery, new liver metastases appeared. He received nab-paclitaxel plus ramucirumab and nivolumab as the second and third-line chemotherapy, respectively. Liver metastases were significantly reduced following these courses of chemotherapy. The patient underwent partial hepatectomy as second conversion surgery. Although nivolumab was continued after the second conversion surgery, new para-aortic lymph node metastasis and bilateral hilar lymph node metastasis appeared. However no new metastasis appeared in the liver and he survived for 60 months after first-line chemotherapy.

Discussion: A second conversion surgery with stageIV gastric cancer after third-line chemotherapy with nivolumab is rare. Multiple hepatectomy as conversion surgery may be an option to control liver metastases.

Conclusion: Multiple hepatectomy as conversion surgery may be effective in controlling liver metastases. However, when to perform conversion surgery and the adequate selection of the patient are the most difficult and important.

Keywords: Conversion surgery; Gastric cancer; Multiple conversion surgery; Nivolumab.

Publication types

Case Reports