A Case of Gastric Cancer with Residual Tumor Only in the Para-Aortic Lymph Nodes after Systemic Chemotherapy followed by Conversion Surgery.
We report the case of a 60-year-old male who was diagnosed with gastric cancer. Upper gastrointestinal endoscopy indicated advanced cancer in the posterior wall of the gastric body. Biopsy revealed poorly differentiated adenocarcinoma. Abdominal computed tomography demonstrated thickening of the gastric wall and enlargement of the regional lymph nodes and of the para-aortic lymph nodes (PAN). The involvement of the PAN extended from the celiac axis to the caudal area of the inferior mesenteric artery [cT3N3aH0P0M1(LYM), stage IV]. Systemic chemotherapy was initiated. After 3 courses of S-1 plus cisplatin combination chemotherapy, the primary lesion and the enlarged lymph nodes revealed marked regression except for a minute residual lesion in the lymph nodes. Upon obtaining informed consent, open distal gastrectomy, D2 lymphadenectomy with PAN dissection, and Roux-en-Y reconstruction were performed. The patient was discharged from the hospital 35 days after the operation. Histopathological examination of the resected samples revealed malignant cells only in the PAN, not in the stomach or in the regional lymph nodes [ypT0N0M1(LYM), stage IV]. Currently, the patient is undergoing postoperative adjuvant chemotherapy with S-1 and has remained well without any recurrence after 6 months following surgery.
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Masayuki
M
Tsutsuyama
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Seiji
S
Ito
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Yuichi
Y
Ito
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Kazunari
K
Misawa
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Jiro
J
Kawakami
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Seiji
S
Natsume
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Norihisa
N
Uemura
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Takashi
T
Kinoshita
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Kenya
K
Kimura
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Yoshiki
Y
Senda
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Tetsuya
T
Abe
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Koji
K
Komori
Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan.
Yasushi
Y
Yatabe
Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
Yasumasa
Y
Niwa
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Yasuhiro
Y
Shimizu
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Taira
T
Kinoshita
Conversion surgery; Gastric cancer; Para-aortic lymph node metastasis