Abstract
BackgroundGastric cancer with multiple liver metastases have poor prognosis. Recently, stage IV gastric cancer patients who respond well to systemic chemotherapy can be treated by gastrectomy. We herein report a case of advanced gastric cancer with liver metastases who was successfully downstaged by systemic chemotherapy and underwent conversion surgery.Case presentationA 60-year-old male patient was diagnosed with gastric cancer with multiple liver metastases [cT3N3M1, stage IV]. After 18 courses of S-1 plus cisplatin combination chemotherapy (S-1 administered orally (80 mg/m2/day) twice a day for 21 consecutive days and cisplatin (60 mg/m2) infused on day 8), marked regression of liver metastasis was achieved, and we performed open total gastrectomy with D2 lymph node dissection. The patient was discharged from the hospital 10 days after the operation. Histopathological examination revealed no malignant cells in the lymph nodes [ypT1bN0M0, stage IA]. S-1 as the adjuvant chemotherapy was administered for 12 months, and the patient is alive without a recurrence for 33 months after surgery.ConclusionsConversion surgery may improve the poor prognosis of gastric cancer.
Highlights
BackgroundSystemic chemotherapy is the standard treatment for stage IV gastric cancer (GC) [1]
Gastric cancer with multiple liver metastases have poor prognosis
Conversion surgery may improve the poor prognosis of gastric cancer
Summary
Systemic chemotherapy is the standard treatment for stage IV gastric cancer (GC) [1]. Conversion surgery for GC is a new issue It is defined as a surgical treatment aiming at an R0 resection after chemotherapy for tumors that were originally unresectable or marginally resectable for technical and/or oncological reasons [5]. We presented a case of conversion surgery for GC with multiple liver metastases treated by S-1 plus cisplatin combination chemotherapy. An enhanced computed tomography scan (eCT) revealed thickening of the anterior wall in the lower gastric body, enlarged lymph nodes along the lesser and greater curvature, and multiple liver metastases (Fig. 2a). After six courses of S-1 plus cisplatin combination chemotherapy, the lymph nodes and multiple liver metastases showed remarkable regression without any adverse effects. S-1 was administered as the adjuvant chemotherapy for 12 months, and the patient is alive without a recurrence for 33 months after surgery
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