Umemura Kotaro, Muroya Takahiro, Yoshida Eri, Umetsu Satoko, Sato Kentaro, Fujita Hiroaki, Hakamada Kenichi
Dept. of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2021 Feb;48(2):233-235.
We report a case of unresectable gastric cancer with para-aortic lymph node metastasis, and multiple liver, lung, and bone metastases leading to conversion therapy. A 70s-year-old man visited previous doctor with epigastralgia. He was diagnosed as stage Ⅳ gastric cancer with para-aortic lymph node metastasis, and multiple liver, lung, and bone metastases by upper gastrointestinal endoscopy, contrast enhanced computer tomography(CT), and positron emission tomography(PET). After a regimen consisting of 6 courses of capecitabine plus cisplatin plus trastuzumab, para-aortic lymph node metastasis and liver, lung, and bone metastases were absent in CT and PET images. So, he visited our department for surgery treatment. We judged curative resection could be achieved for gastric cancer. Total gastrectomy, D2 and paraaortic lymphadenectomy, and cholecystectomy were performed. The histopathological examination of the resected specimen revealed the efficacy of chemotherapy was Grade 2b. The patient was discharge 14 days after the operation, and capecitabine plus trastuzumab was started as adjuvant chemotherapy, and the patient remains alive without recurrence 11 months after surgical treatment.
我们报告一例伴有主动脉旁淋巴结转移以及多发肝、肺和骨转移的不可切除胃癌病例，该病例接受了转化治疗。一名70岁男性因上腹部疼痛就诊于前一位医生。通过上消化道内镜检查、增强计算机断层扫描（CT）和正电子发射断层扫描（PET），他被诊断为Ⅳ期胃癌，伴有主动脉旁淋巴结转移以及多发肝、肺和骨转移。在接受了6个疗程的卡培他滨联合顺铂加曲妥珠单抗治疗后，CT和PET图像显示主动脉旁淋巴结转移以及肝、肺和骨转移均消失。于是，他前来我院接受手术治疗。我们判断该胃癌可实现根治性切除。遂进行了全胃切除术、D2和主动脉旁淋巴结清扫术以及胆囊切除术。切除标本的组织病理学检查显示化疗疗效为2b级。患者术后14天出院，开始接受卡培他滨加曲妥珠单抗作为辅助化疗，手术治疗11个月后患者仍存活且无复发。
