A 62-year-old male patient initially presented at our hospital with a complaint of dyspepsia for the previous 4 months. He had no history of another chronic illness and no family history of gastric cancer. On admission, the physical examination was unremarkable and his functional performance status was Eastern Cooperative Oncology Group (ECOG) 1. On endoscopic biopsy, he was diagnosed as suffering with gastric adenocarcinoma of Borrmann's type III that involved the antrum. Abdominopelvic computed tomography (CT) demonstrated several enlarged perigastric lymph nodes without other obvious metastatic lesions in the liver, except for the dilated intrahepatic and common hepatic ducts. Abdominal ultrasound showed a small hypoechoic lesion in segment 2 of the liver. In June 1997, radical subtotal gastrectomy (D2 resection) and wedge resection of the liver were performed after intraoperative verification of a 1×1 cm sized palpable nodule that was highly suspicious for metastasis. Macroscopically, the stomach revealed a 3.5×4.0 cm sized ulcerofungating mass located at the posterior wall of the antrum, and the diameter of the resected liver mass was 0.8×0.6 cm. Microscopic examination revealed that the gastric mass was a poorly differentiated adenocarcinoma that expanded to the proper muscle along with metastases in 28 of the 44 lymph nodes. As shown in Fig. 1, the resected liver mass was a poorly differentiated adenocarcinoma that showed the same pathology as that of stomach mass, which was compatible with the liver metastasis. The procured tumor-free resection margin of the liver was only 0.2 mm. The patient's final stage was pT2N3M1, and he underwent postoperative combination chemotherapy with 6 cycles of a 5-fluorouracil, etoposide, and cisplatin (FEP) regimen. He has survived for more than 9 years (109+months) without any evidence of recurrence, and the last follow was July 2006. The case is summarized in Table 1.

The second case is a 43-year-old male patient who visited our hospital with complaints of hunger pains for the previous 5 months. His physical examination and laboratory findings were unremarkable, and his performance status was ECOG 1. He was diagnosed as having stomach cancer of Borrmann's type II involving the upper body, and adenocarcinoma was confirmed by endoscopic biopsy. Abdomino-pelvic CT scan showed a single low-attenuated mass in segment 8 of the liver without evidence of other metastasis. Considering the patient's favorable general condition and single hepatic metastasis, radical total gastrectomy (D2 resection) with combined liver resection was performed. The patient also underwent coincidental splenectomy due to intraoperative detection of an enlarged splenic hilar lymph node. On operation, a single 4×4 cm sized mass was discovered in segment 8 of the liver without other evidence of intraabdominal metastasis. Macroscopically, the gastric specimen was an ulcerative lesion that measured 7×9 cm, and it was located at the posterior wall of the cardia and upper body. On multiple cut sections of the liver mass, the parenchyma revealed a 4×4 cm sized well-circumscribed, friable gray tan nodular area that grossly abutted to one of the surgical margins. Histopathologic examination showed moderately differentiated adenocarcinoma extending to the perigastric fat tissue and lymphovascular permeation with metastasis to 13 of the 38 lymph nodes. The resected liver showed a moderately differentiated adenocarcinoma that exhibited the same pathology as that of the stomach mass, which was compatible with the liver metastasis from the gastric cancer (Fig. 2). The final stage was pT3N2M1, and the patient received 12 cycles of postoperative combination chemotherapy of 5-fluorouracil, doxorubicin and mitomycin-C (FAM). The patient has survived for 8 years (94+months) without evidence of recurrence with the last follow-up in July 2006. The case is summarized in Table 1.