Toyota Satoshi, Naito Hiroshi, Motoyoshi Saki, Nakanishi Ryota, Oki Eiji, Orita Hiroyuki, Korenaga Daisuke
Department of Surgery, Nakatsu Municipal Hospital, Nakatsu, Oita, Japan.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Surg Case Rep. 2020 Nov 25;6(1):298. doi: 10.1186/s40792-020-01040-3.
Chemotherapy has been considered the main treatment for stage IV gastric cancer (GC). However, advances in chemotherapy have provided new clinical approaches, permitting conversion surgery with the aim of R0 resection after resolving unresectability issues.
A 70-year-old man with gastric cancer invading the pancreatic tail and spleen and with periaortic lymph-node enlargement was admitted to our hospital. After 24 courses of nivolumab as third-line chemotherapy, periaortic lymph-node enlargement was resolved, and conversion surgery was planned. Intraoperatively, we found no peritoneal metastasis, but the distal pancreas, splenic hilum, and transverse colon were adhered to the gastric body. Therefore, we performed D2 total gastrectomy with distal pancreatosplenectomy and partial transverse colectomy. The pathological diagnosis was type III moderately differentiated tubular adenocarcinoma (tub2) with signet ring cells, stage ypT1b (SM), ly0, and v0. The pathological proximal and distal tumor margins were negative. One lymph-node metastasis was observed (No. 4d; 1/23). Postoperatively, no recurrence was observed over 7 months, without adjuvant chemotherapy.
Nivolumab may allow R0 resection in patients with unresectable gastric cancer. Conversion surgery should be considered even after third-line nivolumab treatment.
化疗一直被认为是IV期胃癌（GC）的主要治疗方法。然而，化疗的进展提供了新的临床方法，使得在解决不可切除问题后，能够进行旨在实现R0切除的转化手术。
一名70岁男性因胃癌侵犯胰尾和脾脏且腹主动脉旁淋巴结肿大入住我院。在接受24个疗程的纳武单抗作为三线化疗后，腹主动脉旁淋巴结肿大得到缓解，并计划进行转化手术。术中，我们未发现腹膜转移，但远端胰腺、脾门和横结肠与胃体粘连。因此，我们进行了D2全胃切除术，同时行远端胰脾切除术和部分横结肠切除术。病理诊断为III型中分化管状腺癌（tub2）伴印戒细胞，ypT1b（SM）期，ly0，v0。病理切缘近端和远端均为阴性。观察到1处淋巴结转移（第4d组；1/23）。术后7个月未观察到复发，未进行辅助化疗。
纳武单抗可能使不可切除胃癌患者实现R0切除。即使在接受三线纳武单抗治疗后，也应考虑进行转化手术。
