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Liver resection is now widely accepted as a potentially curative treatment for colorectal liver metastasis. However, the efficacy of surgical resection for gastric cancer liver metastasis(GLM)remains unclear. Based on our 18-year experience with 64 patients who underwent curative hepatectomy for GLM, we discuss the indication and efficacy of surgical resection for GLM. From January 1993 to January 2011, 73 patients underwent hepatectomy for GLM in the Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital(Japanese Foundation for Cancer Research), Japan. The actuarial1 -, 3-, and 5-year overall survival rates and 1-, 3-, and 5-year recurrence-free survival rates of those 64 patients who achieved curative resections were 84, 50, and 37%, and 42, 27, and 27%, respectively. By multivariate analysis, serosal invasion of the primary gastric cancer and larger hepatic tumor(>5 cm in diameter)were found to be independent indicators of poor prognosis. Based on the multivariate analysis results, all patients were divided into three groups no poor prognostic factor(n=38), one poor prognostic factor(n=24), and two poor prognostic factors(n=2). The actuarial overall survival rates of each group were 63, 36, and 0% at 3 years, and 53, 15, and 0% at 5 years. GLM patients having hepatic tumors with the maximum diameter of <5 cm, and without serosalinvasion of the primary gastric cancer, are the best candidates for hepatectomy.

We report a 49-year-old man with unresectable intrahepatic cholangiocarcinoma (ICC) who was treated with oral tegafur-uracil (UFT) chemotherapy and survived for over a decade. In 1995, the patient was admitted to our institution after a large tumor in his left liver was detected using computed tomography (CT). The tumor was diagnosed as ICC, and a laparotomy was performed; however, the tumor was too advanced to perform a curative resection. The cancer had spread to the lymph nodes in the hepatoduodenal ligament and on the posterior surface of the pancreas head. A curative resection was abandoned, and oral UFT chemotherapy was started immediately after the laparotomy. The tumor remained almost unchanged until 2001 with only UFT administration; however, its size gradually increased to 7.8 cm in diameter. External-beam radiotherapy (50.4 Gy) was performed, and the tumor's size decreased to 6.3 cm in diameter. Eleven years have now passed since the laparotomy, and the patient continues to lead a normal daily life working as a banker. The cumulative dose of UFT has reached 2511 g without any significant adverse effects. This case suggests that oral UFT might suppress the progression of ICC, contributing to this patient's 11-year survival period.

The mortality rate of fulminant hepatic failure was high until liver transplantation was presented as a potential therapy. We encountered a patient with hyperacute fulminant hepatic failure due to hepatitis B virus infection. Living donor liver transplantation was planned but abandoned because her brain edema progressed too rapidly to complete the donor evaluation. The present case reveals the limitation of living donor liver transplantation as a treatment for hyperacute fulminant hepatic failure.

A 68-year-old woman was admitted to our hospital because of type 4 gastric cancer associated with paraaortic lymph node metastasis. Considered surgically incurable, she was placed on preoperative chemotherapy consisting of Methotrexate (MTX) 50 mg (day 1), CDDP 10 mg (day 2-6), 5-FU 500 mg (day 1-6) and Leucovorin (LV) 60 mg (day 2-6). Because of severe nausea and leucopenia, she could receive only 1 course of the chemotherapy. CT on January 7, 1997 (5 weeks after the chemotherapy) showed that the gastric wall thickness and the paraaortic lymph nodes swelling had decreased remarkably. She underwent total gastrectomy on January 13, 1997 (pT2, pN2, pM1 (LYM), stage IV, TNM classification). As an outpatient, she was treated with UFT-E 300 mg/day (continuous until the present) and MTX 50 mg (day 1), 5-FU 500 mg (day 1) and LV 60 mg (day 2-3) once two weeks (total 27 cycles). Four years and 4 months after surgery, although peritoneal recurrence was suspected, she has been managed at our outpatient clinic.

A 63-year-old man was admitted to our hospital because of advanced gastric cancer associated with metastasis of the liver. He was treated with 300 mg/day of UFT-E from 18 days after total gastrectomy on July 14, 1997. The preoperative serum level of tumor marker, which had been increasing (CEA: 340 ng/ml, CA19-9: 9,094 U/ml), returned to the normal range 7 months after gastrectomy. CT scan on July 9, 1998 (1 year after gastrectomy) showed that the liver metastasis had changed to a scar (CR). As of May, 2001, 2 years and 10 months after inducing CR, we have been administering UFT-E to the patient, with no side effect or regrowth of the tumor.