A case of stage IV gastric cancer with para-aortic lymph node metastasis showing pathological complete response after neoadjuvant chemotherapy
Abstract Background Stage IV advanced gastric cancer with para-aortic lymph node metastasis (PALM) is considered unresectable. Systemic chemotherapy is the treatment of choice for such tumors, while conversion surgery may be a treatment option in the case chemotherapy is effective but R0 resection i...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Japan Surgical Society
2020-01-01
|
| Series: | Surgical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40792-020-0788-1 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849709446022823936 |
|---|---|
| author | Yuki Katsura Takehiro Okabayashi Manabu Matsumoto Kazuhide Ozaki Yuichi Shibuya |
| author_facet | Yuki Katsura Takehiro Okabayashi Manabu Matsumoto Kazuhide Ozaki Yuichi Shibuya |
| author_sort | Yuki Katsura |
| collection | DOAJ |
| description | Abstract Background Stage IV advanced gastric cancer with para-aortic lymph node metastasis (PALM) is considered unresectable. Systemic chemotherapy is the treatment of choice for such tumors, while conversion surgery may be a treatment option in the case chemotherapy is effective but R0 resection is possible. We report a case of stage IV gastric cancer with PALM that showed pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) using S-1, oxaliplatin, and trastuzumab (SOX+HER). Case presentation A 69-year-old woman who was diagnosed with type 4 stage IV gastric cancer with PALM underwent five courses of NAC with the SOX+HER regimen. The primary tumor and the PALM shrank after treatment, suggesting that the NAC induced a partial response. We performed a total gastrectomy plus distal pancreaticosplenectomy with para-aortic lymph node dissection. Histological analysis revealed no remnant cancer cells in the primary tumor or the lymph nodes, confirming a pCR. The postoperative course was uneventful, and the patient was discharged on day 14 after the operation. S-1 was started as adjuvant chemotherapy, and the patient remains alive without recurrence 2 months after surgery. Conclusion This case shows the possibility of conversion surgery after SOX+HER therapy for stage IV advanced gastric cancer with PALM. |
| format | Article |
| id | doaj-art-1d70014f003b44829caa61b75c42e692 |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-1d70014f003b44829caa61b75c42e6922025-08-20T03:15:17ZengJapan Surgical SocietySurgical Case Reports2198-77932020-01-01611510.1186/s40792-020-0788-1A case of stage IV gastric cancer with para-aortic lymph node metastasis showing pathological complete response after neoadjuvant chemotherapyYuki Katsura0Takehiro Okabayashi1Manabu Matsumoto2Kazuhide Ozaki3Yuichi Shibuya4Department of Gastroenterological Surgery, Kochi Health Sciences CenterDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterDepartment of Diagnostic Pathology, Kochi Health Sciences CenterDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterAbstract Background Stage IV advanced gastric cancer with para-aortic lymph node metastasis (PALM) is considered unresectable. Systemic chemotherapy is the treatment of choice for such tumors, while conversion surgery may be a treatment option in the case chemotherapy is effective but R0 resection is possible. We report a case of stage IV gastric cancer with PALM that showed pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) using S-1, oxaliplatin, and trastuzumab (SOX+HER). Case presentation A 69-year-old woman who was diagnosed with type 4 stage IV gastric cancer with PALM underwent five courses of NAC with the SOX+HER regimen. The primary tumor and the PALM shrank after treatment, suggesting that the NAC induced a partial response. We performed a total gastrectomy plus distal pancreaticosplenectomy with para-aortic lymph node dissection. Histological analysis revealed no remnant cancer cells in the primary tumor or the lymph nodes, confirming a pCR. The postoperative course was uneventful, and the patient was discharged on day 14 after the operation. S-1 was started as adjuvant chemotherapy, and the patient remains alive without recurrence 2 months after surgery. Conclusion This case shows the possibility of conversion surgery after SOX+HER therapy for stage IV advanced gastric cancer with PALM.https://doi.org/10.1186/s40792-020-0788-1Gastric cancerPara-aortic lymph node metastasisConversion surgeryPathological complete response |
| spellingShingle | Yuki Katsura Takehiro Okabayashi Manabu Matsumoto Kazuhide Ozaki Yuichi Shibuya A case of stage IV gastric cancer with para-aortic lymph node metastasis showing pathological complete response after neoadjuvant chemotherapy Surgical Case Reports Gastric cancer Para-aortic lymph node metastasis Conversion surgery Pathological complete response |
| title | A case of stage IV gastric cancer with para-aortic lymph node metastasis showing pathological complete response after neoadjuvant chemotherapy |
| title_full | A case of stage IV gastric cancer with para-aortic lymph node metastasis showing pathological complete response after neoadjuvant chemotherapy |
| title_fullStr | A case of stage IV gastric cancer with para-aortic lymph node metastasis showing pathological complete response after neoadjuvant chemotherapy |
| title_full_unstemmed | A case of stage IV gastric cancer with para-aortic lymph node metastasis showing pathological complete response after neoadjuvant chemotherapy |
| title_short | A case of stage IV gastric cancer with para-aortic lymph node metastasis showing pathological complete response after neoadjuvant chemotherapy |
| title_sort | case of stage iv gastric cancer with para aortic lymph node metastasis showing pathological complete response after neoadjuvant chemotherapy |
| topic | Gastric cancer Para-aortic lymph node metastasis Conversion surgery Pathological complete response |
| url | https://doi.org/10.1186/s40792-020-0788-1 |
| work_keys_str_mv | AT yukikatsura acaseofstageivgastriccancerwithparaaorticlymphnodemetastasisshowingpathologicalcompleteresponseafterneoadjuvantchemotherapy AT takehirookabayashi acaseofstageivgastriccancerwithparaaorticlymphnodemetastasisshowingpathologicalcompleteresponseafterneoadjuvantchemotherapy AT manabumatsumoto acaseofstageivgastriccancerwithparaaorticlymphnodemetastasisshowingpathologicalcompleteresponseafterneoadjuvantchemotherapy AT kazuhideozaki acaseofstageivgastriccancerwithparaaorticlymphnodemetastasisshowingpathologicalcompleteresponseafterneoadjuvantchemotherapy AT yuichishibuya acaseofstageivgastriccancerwithparaaorticlymphnodemetastasisshowingpathologicalcompleteresponseafterneoadjuvantchemotherapy AT yukikatsura caseofstageivgastriccancerwithparaaorticlymphnodemetastasisshowingpathologicalcompleteresponseafterneoadjuvantchemotherapy AT takehirookabayashi caseofstageivgastriccancerwithparaaorticlymphnodemetastasisshowingpathologicalcompleteresponseafterneoadjuvantchemotherapy AT manabumatsumoto caseofstageivgastriccancerwithparaaorticlymphnodemetastasisshowingpathologicalcompleteresponseafterneoadjuvantchemotherapy AT kazuhideozaki caseofstageivgastriccancerwithparaaorticlymphnodemetastasisshowingpathologicalcompleteresponseafterneoadjuvantchemotherapy AT yuichishibuya caseofstageivgastriccancerwithparaaorticlymphnodemetastasisshowingpathologicalcompleteresponseafterneoadjuvantchemotherapy |