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We present a case involving successfully repeated resection of metachronous liver metastases from an early alpha-fetoprotein (AFP)-producing gastric cancer (APGC). A 76-year-old male initially underwent laparoscopy-assisted distal gastrectomy (LADG) for early APGC in September 2010. Five months after the LADG, the serum AFP increased to 1871 ng/ml, and multiple liver metastases were detected in Segment 1 (S1), S6, and S8 using computed tomography (CT) and magnetic resonance imaging (MRI). Percutaneous biopsy specimens from the liver tumor revealed hepatoid adenocarcinoma that stained positive for AFP. A partial S1 and S8 hepatectomy and S6 segmentectomy were performed in March 2011. The AFP level decreased to 5 ng/ml within 2 months of the hepatectomy, but increased again to 25 ng/ml 10 months later. CT and MRI revealed a small tumor in S2, and he underwent partial resection of S2 in February 2012. Pathological and immunohistochemical analyses also showed hepatoid adenocarcinoma that stained positive for AFP. His serum AFP level returned to normal, but increased again to 125 ng/ml 11 months later. As CT and MRI showed a tumor in S3, lateral segmentectomy was performed in February 2013. His serum AFP level decreased again to 3 ng/ml, and there has been no evidence of further metastasis in the 6 months since the third hepatectomy. We report this case to show that repeated surgical resection of metachronous liver metastasis from early APGC is feasible and might prolong survival. |
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