Kondo Masato, Nishino Shogo, Yamashita Daisuke, Kaihara Satoshi
Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan.
Case Rep Oncol. 2020 Jun 24;13(2):716-720. doi: 10.1159/000507983. eCollection 2020 May-Aug.
The prognosis of locally advanced gastric cancer is poor even if radical gastrectomy with D2 lymphadenectomy is followed by adjuvant chemotherapy. Hence, neoadjuvant chemotherapy is performed to try to improve the prognosis, as it can significantly downstage the tumor and safely improve the R0 resection rate of patients. Herein, we report a case of locally advanced gastric cancer with pancreatic invasion and gastric outlet obstruction that showed a pathological complete response after neoadjuvant chemotherapy with S-1 and oxaliplatin (SOX). A 74-year-old man presented to our hospital with abdominal pain and pyloric stenosis. CT images revealed a cStage IVb, cT4b tumor in the pancreas, cN1, cM0. Therefore, we performed laparoscopic gastrojejunostomy, and the patient's oral intake improved after surgery; we then administered neoadjuvant chemotherapy with SOX on postoperative day 18, without any surgical complications. After 3 courses of neoadjuvant chemotherapy, the patient underwent radical distal gastrectomy, thereby avoiding pancreatoduodenectomy. Histopathological examination of the resected sample revealed no residual cancer cells, indicating a pathological complete response. No recurrence has occurred for 1 year after surgery. Thus, neoadjuvant chemotherapy with SOX can help in tumor downstaging and may be a multipotent option for the treatment of locally advanced gastric cancer, such as cases with the invasion of other organs; this treatment can result in improved curability and avoid overinvasive surgery.
即使采用D2淋巴结清扫的根治性胃切除术并辅以辅助化疗，局部进展期胃癌的预后仍然很差。因此，进行新辅助化疗以试图改善预后，因为它可以显著降低肿瘤分期并安全提高患者的R0切除率。在此，我们报告一例局部进展期胃癌伴胰腺侵犯和胃出口梗阻的病例，该病例在接受S-1和奥沙利铂（SOX）新辅助化疗后显示出病理完全缓解。一名74岁男性因腹痛和幽门狭窄就诊于我院。CT图像显示为cStage IVb、胰腺cT4b肿瘤、cN1、cM0。因此，我们进行了腹腔镜胃空肠吻合术，术后患者的经口摄入量有所改善；然后在术后第18天给予SOX新辅助化疗，未出现任何手术并发症。经过3个疗程的新辅助化疗后，患者接受了根治性远端胃切除术，从而避免了胰十二指肠切除术。切除样本的组织病理学检查显示无残留癌细胞，表明病理完全缓解。术后1年未出现复发。因此，SOX新辅助化疗有助于降低肿瘤分期，对于局部进展期胃癌的治疗可能是一种多能选择，例如侵犯其他器官的病例；这种治疗可以提高治愈率并避免过度侵入性手术。
