Metastases occur most commonly in the liver and peritoneal surfaces and are strongly correlated to mitotic activity and size. Since the resected tumour in our patient measured 23 cm and had 20 mitoses per 50 high-power fields, he should be closely followed up postoperatively. It is believed that these residual tumour cells usually take some time to reach a sufficient size to compress the gastrointestinal tract, and by that time widespread metastases are evident. Anticancer drugs should be given to suppress the proliferation of the residual tumour cells. Although several requirements should be met for a drug to be considered for intraperitoneal use in patients with locally recurrent or persistent peritoneal disease, no specifically effective drugs against leiomyosarcomas are known.
Surgical resection is the treatment of choice for gastric leiomyosarcomas.
Every effort should be made to excise the tumour completely with an adequate margin of uninvolved tissue. It is sometimes difficult, however, to resect such a tumour segmentally due to numerous feeding arteries at its surface. The great deterrent to resection of an abdominal tumour is the risk of hemorrhage due to the tumour's vascularity. It might be argued that although some lesions may be pathologically benign at the time of removal, they could become malignant if left alone. Therefore we believe that total gastrectomy offers the best palliation for patients having this tumour.