Tsunematsu Masashi, Takahashi Naoto, Murakami Keishiro, Misawa Takeyuki, Akiba Tadashi, Yanaga Katsuhiko
Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba Prefecture, 277-8567, Japan.
Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan.
Surg Case Rep. 2017 Aug 29;3(1):95. doi: 10.1186/s40792-017-0372-5.
Gastric 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.
A 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/m/day) twice a day for 21 consecutive days and cisplatin (60 mg/m) 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.
Conversion surgery may improve the poor prognosis of gastric cancer.
伴有多发肝转移的胃癌预后较差。近来，对全身化疗反应良好的IV期胃癌患者可接受胃切除术治疗。我们在此报告一例伴有肝转移的晚期胃癌患者，其通过全身化疗成功降期并接受了转化手术。
一名60岁男性患者被诊断为伴有多发肝转移的胃癌[cT3N3M1，IV期]。在接受18个疗程的S-1加顺铂联合化疗（S-1口服（80mg/m²/天），每天两次，连续21天，顺铂（60mg/m²）于第8天静脉滴注）后，肝转移灶明显缩小，我们对其进行了D2淋巴结清扫的开放全胃切除术。患者术后10天出院。组织病理学检查显示淋巴结无癌细胞[ypT1bN0M0，IA期]。给予S-1辅助化疗12个月，患者术后33个月存活且无复发。
转化手术可能改善胃癌的不良预后。
