Surgeons in France who treated a patient with gastric metastasis of renal cell carcinoma (RCC) were prompted to conduct a systematic review of the literature to find all published similar cases. They aimed to determine how rare that particular site of solitary metastasis is, as well as to understand outcomes in this small patient population. The case study and results of the literature review were recently published in the International Journal of Surgery Case Reports.
The literature review revealed only 11 other cases of solitary gastric metastasis, and the condition is associated with poor outcomes.
The median time from RCC diagnosis and detection of solitary gastric metastasis was 8.5 years (range, 3.8-19.3). Median patient age at time of metastasis detection was 68 years, and 82% of the patients were men. Locations of metastasis were middle body of the stomach (45%), followed by upper body of the stomach (36%) and lower body of the stomach (18%). Gastrointestinal bleeding and anemia were the most common symptoms.
Most patients received surgical resection (64%) or endoscopic submucosal resection (27%). Only one patient received palliative chemotherapy. Median patient survival was 9 months (range, 3.4-15.8). Median survival was higher after surgical treatment (9 months [range, 3.4-15.8] versus 6 months [range, 2.5-24.0]). Three of the 11 patients had metastatic recurrence.
The authors also reviewed their case, which began in December 2010, when a 61-year-old man received open partial nephrectomy for localized clear cell RCC. About eight years later, solitary gastric metastasis was discovered. The surgical team performed a laparoscopic wedge resection, converted to laparotomy. Two years later, scans revealed adenopathy, leading to lymph node dissection of the hepatic hilum and the hepatic artery. The authors’ patient remained healthy after two-year follow-up.
“Surgical treatment, when it is feasible, remains the best therapeutic option for a solitary gastric metastasis, resulting in significant survival prolongation in eligible patients,” wrote the authors, led by Thomas Prudhomme of Toulouse University Hospital in France.