Abstract

Background

Stage IV advanced gastric cancer with para-aortic lymph node metastasis (PALM) is considered unresectable. Systemic chemotherapy is the treatment of choice for such tumors, while conversion surgery may be a treatment option in the case chemotherapy is effective but R0 resection is possible. We report a case of stage IV gastric cancer with PALM that showed pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) using S-1, oxaliplatin, and trastuzumab (SOX+HER).

Case presentation

A 69-year-old woman who was diagnosed with type 4 stage IV gastric cancer with PALM underwent five courses of NAC with the SOX+HER regimen. The primary tumor and the PALM shrank after treatment, suggesting that the NAC induced a partial response. We performed a total gastrectomy plus distal pancreaticosplenectomy with para-aortic lymph node dissection. Histological analysis revealed no remnant cancer cells in the primary tumor or the lymph nodes, confirming a pCR. The postoperative course was uneventful, and the patient was discharged on day 14 after the operation. S-1 was started as adjuvant chemotherapy, and the patient remains alive without recurrence 2 months after surgery.

Conclusion

This case shows the possibility of conversion surgery after SOX+HER therapy for stage IV advanced gastric cancer with PALM.

Details

Title
A case of stage IV gastric cancer with para-aortic lymph node metastasis showing pathological complete response after neoadjuvant chemotherapy
Author
Katsura Yuki 1 ; Okabayashi Takehiro 1 ; Matsumoto, Manabu 2 ; Ozaki Kazuhide 1 ; Shibuya Yuichi 1 

 Kochi Health Sciences Center, Department of Gastroenterological Surgery, Kochi City, Japan 
 Kochi Health Sciences Center, Department of Diagnostic Pathology, Kochi City, Japan 
Publication year
2020
Publication date
Jan 2020
Publisher
International Academic Publishing Co Ltd.
e-ISSN
21987793
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2343359571
Copyright
Surgical Case Reports is a copyright of Springer, (2020). All Rights Reserved. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.