Search

Purpose: The prognosis of patients with liver metastasis from gastric cancer is poor and the optimal treatment remains undetermined. This study identified prognostic factors for survival of patients with metachronous liver metastasis with no other metastatic site after gastrectomy for primary gastric cancer. We also evaluated the clinical impact of hepatic resection. Methods: Between 1997 and 2013, 19,588 curative gastrectomies for gastric adenocarcinoma were performed and 52 patients were diagnosed with metastasis to only the liver. We retrospectively analyzed the clinicopathologic factors of these patients. Results: The median time from gastrectomy to diagnosis of liver metastasis was 16 months (range, 1–65 months). Median survival time after the diagnosis of liver metastasis was 13 months (range, 3–64 months). The 1-year, 2-year, and 3-year patient survival rates after diagnosis of liver metastasis were 53.8%, 26.6%, and 19.9%, respectively. Twelve patients (23%) underwent liver resection for liver metastasis. The 1-year, 3-year, and 5-year overall survival rates were 92%, 42%, and 42% in the hepatic resection group and 43%, 13%, and 7% in the non-hepatic resection group (P=0.002). Multivariate analysis showed that hepatic resection, pathologic stage Ⅰ and Ⅱ of the primary tumor, and intestinal type in Lauren classification were predisposing factors for patient survival. Conclusion: Liver resection for resectable metachronous liver metastasis diagnosed after curative gastrectomy increases survival in patients with pathologic stage Ⅰ or Ⅱ and intestinal type in Lauren classification for the primary tumor.

Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and perforation. This report describes a very rare complication of an enterovesical fistula associated with chronic Meckel diverticulum. A 51-year-old male presented with over 10 years of persistent pyuria. Tests were performed to rule out malignancy, including serum prostate-specific antigen level, urine cytology, bacterial culture, cystoscopy, and bladder computed tomography. An enterovesical fistula was identified, and laparoscopic exploration was performed. The findings suggested enterovesical fistula formation caused by chronic inflammation at the tip of a Meckel diverticulum. Segmental resection of the small bowel including the diverticulum and primary repair of the urinary bladder along with partial cystectomy were performed. The postoperative clinical course was uneventful. An enterovesical fistula is a very rare complication resulting from chronic inflammation of a Meckel diverticulum.