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[A Case of Long-Term Survival after Multimodal Therapy against Gastric GIST with Multiple Hepatic Metastasis].

A male in his forties experiencing epigastric pain visited our hospital and was diagnosed with a large gastric gastrointestinal stromal tumor(GIST)invading pancreatic tail with synchronous multiple liver metastases. We diagnosed as unresectable and started imatinib. Two weeks later, tumor necrosis and penetration were occurred. We performed partial gastrectomy with pancreatic tail resection and splenectomy. During the surgery, we also performed radiofrequency ablation(RFA)on all the liver metastases. After surgery, we immediately resumed imatinib. Four years after surgery, metastatic lesion in liver S4/8 was detected, RFA was performed and Imatinib was continued. Eight years after surgery, a recurrent metastatic lesion of the liver coincident with the previous RFA site was detected. We performed a right hepatic lobectomy and he continued imatinib, Currently, 16 years after the first operation, he is alive under the imatinib continuation. This case demonstrates that the combination of surgery, RFA and imatinib can be effective for prolonging survival in patients with advanced gastric GIST with synchronous multiple liver metastases.