[Complete Response with Neoadjuvant Chemotherapy and Curative Resection in a Case of Locally Advanced Gastric Cancer That Was Strongly Positive for HER2 with Multiple Liver Metastases].

As a part of community screening, a 64-year-old man underwent gastric fluoroscopy, which revealed abnormalities indicative of a type 3 tumor. Contrast-enhanced abdominal computed tomography showed advanced gastric cancer with multiple regional lymph nodes and liver metastases. Chemotherapy was initiated, and after completion of 2 courses of capecitabine (Cape)and oxaliplatin(OHP)therapy, a distalgastrectomy was performed. The response to chemotherapy was Grade 2, and the lymph node status was pN1(1/17). The patient was strongly positive for HER2; thus, 4 courses of Cape, OHP, and trastuzumab(T-mab)therapy were administered for the metastatic liver lesions, and the liver metastases shrank markedly. S5 subsegmentectomy and S7 partial resection were performed subsequently, and pathological analysis showed completely necrotic tissue. Remarkable progress has been made in chemotherapy for gastric cancer, and the use of T-mab in combination is extremely effective for gastric cancer that is strongly positive for HER2. In our patient, we resected the primary lesion and liver metastatic lesions after neoadjuvant chemotherapy. The metastatic lesion showed complete response(CR). Metastases and recurrences can even occur in patients with primary and/or metastatic lesions who show a CR. Furthermore, whether cancers that are strongly positive for HER2 are recurrent remains unknown. The patient is alive and recurrence-free after having undergone a hepatectomy.

Effects of partial hepatic venous congestion on hepatic hemodynamics and histology.

BACKGROUND/AIMS: Extensive liver resection potentially causes hepatic venous congestion resulting in critical liver damage. The effects of partial hepatic venous congestion on hepatic hemodynamics and histology were studied. METHODOLOGY: Male Wistar rats underwent hepatic vein ligation of left lateral lobe (35%) or left lateral and median lobes (70%). Systemic and hepatic hemodynamics was measured following hepatic vein ligation of 35% lobe. RESULTS: Rats with 35% hepatic venous congestion survived while rats with 70% hepatic venous congestion died within 2 days after surgery. Blood pressure of carotid artery and central vein, and blood flow of hepatic artery and portal vein transiently decreased after surgery (p < 0.05), while portal venous pressure increased significantly after surgery (p < 0.05). Partial hepatic venous congestion blocked portal flow to the congested lobe, and blood flow of the congested lobe was maintained only by hepatic arterial flow. Partial hepatic venous congestion caused massive necrosis of hepatocytes in the central vein lobules and intermediate area, while hepatocytes in the periportal area were being preserved. CONCLUSIONS: These results suggest that in patients undergoing extensive liver resection or LDLT, preservation of hepatic arterial flow or hepatic vein reconstruction of the congested area should be recommended depending on congested liver volume.