A case of long-term survival after splenectomy for solitary splenic metastasis from gastric cancer.

Publisher: BioMed Central Country of Publication: England NLM ID: 101170544 Publication Model: Electronic Cited Medium: Internet ISSN: 1477-7819 (Electronic) Linking ISSN: 14777819 NLM ISO Abbreviation: World J Surg Oncol Subsets: MEDLINE

Original Publication: London : BioMed Central, 2003-

Splenic Neoplasms*/diagnostic imaging ; Splenic Neoplasms*/surgery ; Stomach Neoplasms*/surgery; Aged, 80 and over ; Gastrectomy ; Humans ; Male ; Neoplasm Recurrence, Local/surgery ; Prognosis ; Splenectomy

Background: Very rarely does a splenic solitary metastasis arise from a gastric carcinoma because splenic metastasis is usually seen in association with widespread visceral metastasis. Splenectomy is considered to be a curative treatment; however, long-term prognosis after splenectomy has scarcely been reported. We report a case of a metachronous and solitary metastasis to the spleen from gastric cancer in which the patient achieved 5-year recurrence-free survival after splenectomy.
Case Presentation: An 84-year-old man underwent an open total gastrectomy involving D1+ lymph nodes dissection for gastric cancer located in the cardia (pT3N1M0, pStage IIB). Eighteen months later, a 2-cm solitary hypodense lesion was detected in the spleen by computed tomography (CT). Twenty-three months later, the serum carcinoembryonic antigen (CEA) value elevated to 19.9 ng/ml, and abdominal CT revealed an increase in tumor size to 5 cm. Positron-emission tomography (PET)-CT revealed intense ¹⁸ F-2-deoxy-2-fluoro-glucose (FDG) uptake in the spleen without the involvement of other organs and lymph nodes. We diagnosed him with solitary splenic metastasis from gastric cancer and performed a splenectomy 26 months after the first surgery. Histological examination revealed that the splenic tumor was a moderately differentiated adenocarcinoma, which was very similar to the primary gastric tumor; the lesion was diagnosed as a metastatic tumor from the previous gastric carcinoma. The patient remains healthy to date without recurrence, 5 years after the splenectomy.
Conclusion: We experienced a case of a solitary splenic metastasis from gastric cancer in which 5-year recurrence-free survival was achieved after splenectomy. To determine the surgical indication in patients with splenic metastasis, it is important to differentiate between a solitary lesion or multiple metastasis. Especially, occult metastasis should be excluded by means of several months of follow-up with imaging tests and systemic FDG-PET surveys before splenectomy.

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Keywords: Gastric cancer; Splenectomy; Splenic metastasis

Date Created: 20200920 Date Completed: 20210514 Latest Revision: 20210514

20231215

PMC7502201

10.1186/s12957-020-02024-1

32950063