Choi YJ, Kim DH, Han HS, Han JH, Son SM, Kim DS, Yun HY. Long-term survival after gastrectomy and metastasectomy for gastric cancer with synchronous bone metastasis. World J Gastroenterol 2018; 24(1): 150-156 [PMID: 29358891 DOI: 10.3748/wjg.v24.i1.150]
Corresponding Author of This Article
Hyo Yung Yun, MD, PhD, Professor, Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju 28644, South Korea. yunhyo@chungbuk.ac.kr
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 7, 2018; 24(1): 150-156 Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.150
Long-term survival after gastrectomy and metastasectomy for gastric cancer with synchronous bone metastasis
Young Jin Choi, Dae Hoon Kim, Hye Suk Han, Joung-Ho Han, Seung-Myoung Son, Dong Soo Kim, Hyo Yung Yun
Young Jin Choi, Dae Hoon Kim, Hyo Yung Yun, Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
Hye Suk Han, Joung-Ho Han, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
Seung-Myoung Son, Department of Pathology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
Dong Soo Kim, Department of Orthopedics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
Author contributions: Choi YJ and Kim DH wrote the manuscript; Kim DS and Yun HY designed and revised the manuscript; Han HS, Han JH and Son SM participated in collection of the medical data; Choi YJ, Kim DH and Yun HY are responsible for accuracy of the case; all authors read and approved the final manuscript.
Informed consent statement: Informed consent was obtained from the patient for this case report.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hyo Yung Yun, MD, PhD, Professor, Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju 28644, South Korea. yunhyo@chungbuk.ac.kr
Telephone: +82-43-2696032 Fax: +82-43-2666037
Received: October 30, 2017 Peer-review started: October 31, 2017 First decision: November 8, 2017 Revised: November 18, 2017 Accepted: November 27, 2017 Article in press: November 27, 2017 Published online: January 7, 2018 Processing time: 68 Days and 20.2 Hours
ARTICLE HIGHLIGHTS
Case characteristics
A 53-year-old man, referred after detection of a tumorous bony lesion in the 2nd lumbar vertebra during evaluation for back pain.
Clinical diagnosis
The patient had no significant medical history, except for having undergone gastrectomy due to gastric ulcer 15 years prior.
Differential diagnosis
Primary bone neoplasm, metastatic bone tumor.
Laboratory diagnosis
Serum alkaline phosphatase, calcium, carcinoembryonic antigen (CEA), cancer antigen (CA) 19-9 and lactate dehydrogenase (LDH) levels were within normal range.
Imaging diagnosis
Magnetic resonance imaging of the spine showed a suspicious metastatic lesion in the 2nd lumbar vertebra, with enhancing signal intensity on a T2-weighted image. Gastroduodenoscopy showed a Borrmann type III lesion at the remnant stomach lesser curvature.
Pathological diagnosis
A bone biopsy taken at the 2nd lumbar vertebra led to diagnosis of metastatic adenocarcinoma. Gastric lesion was diagnosed as poorly differentiated adenocarcinoma by biopsy.
Treatment
The patient underwent total gastrectomy and lumbar vertebrae metastasectomy, followed by aggressive palliative chemotherapy.
Related reports
Gastric cancer with bone metastasis is relatively rare and associated with poor prognosis. Known factors associated with longer median survival times for patients with bone metastasis include isolated bone metastasis, well differentiated tumors, palliative chemotherapy and zoledronic acid treatment. On the other hand, high-level LDH, CEA and CA19-9, serum hypercalcemia, poor performance status, and involvement of multiple bones are associated with shorter survival times. Small studies have reported survival gain in gastric cancer patients with synchronous distant metastasis who underwent resectable gastric surgery plus metastasectomy.
Term explanation
Gastrectomy is a partial or total surgical removal of the stomach. Metastasectomy is the surgical removal of metastases, which are secondary cancerous growths that have spread from cancer originating in another organ in the body.
Experiences and lessons
Aggressive local therapy, including gastrectomy with metastasectomy and palliative chemotherapy, may be an effective therapeutic option for improving survival in patients with resectable primary gastric cancer and bone metastasis.
