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Conversion surgery after S-1 plus oxaliplatin combination chemotherapy for advanced gastric cancer with multiple liver metastases

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Abstract

Conversion therapy for gastric cancer is a new therapeutic concept. We report a case of a patient with advanced gastric cancer who underwent conversion surgery due to a remarkable regression of multiple liver metastases following chemotherapy. A 71-year-old man was referred to our hospital with gastric cancer. Esophagogastroduodenoscopy (EGD) revealed an irregular, nodular, ulcerated lesion in the lower third of the stomach. Analysis of biopsy specimens revealed a poorly differentiated adenocarcinoma. Abdominal contrast-enhanced computed tomography (CT) showed multiple liver mass lesions. The patient was clinically diagnosed with advanced gastric cancer with liver metastases and received S-1 plus oxaliplatin chemotherapy. After 6 cycles of chemotherapy, CT and magnetic resonance imaging showed complete resolution of the liver metastases, and EGD detected mucosal irregularities only. Since there was no evidence of further metastatic lesions in other organs, the patient underwent distal gastrectomy with D2 lymphadenectomy. The gross appearance of the surgically resected specimen showed a slightly elevated tumor measuring 4.5 × 3.5 cm. Pathological examination confirmed the diagnosis of a moderately differentiated gastric adenocarcinoma invading the muscularis propria with no lymph node metastases. The postoperative course was uneventful. The patient has continued to receive S-1 and oxaliplatin chemotherapy, and there has been no evidence of recurrence for 3 months following the operation. We propose that conversion therapy might be an effective treatment for patients with advanced gastric cancer; however, further studies and assessments are needed to confirm and establish this treatment strategy.

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Authors and Affiliations

  1. Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan

    Tsutomu Namikawa, Sachi Tsuda, Kazune Fujisawa, Jun Iwabu, Sunao Uemura, Shigehiro Tsujii, Hiroyuki Kitagawa & Kazuhiro Hanazaki

  2. Cancer Treatment Center, Kochi Medical School Hospital, Kochi, Japan

    Hiromichi Maeda & Michiya Kobayashi

  3. Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan

    Michiya Kobayashi

Authors
  1. Tsutomu Namikawa
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  2. Sachi Tsuda
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  3. Kazune Fujisawa
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  4. Jun Iwabu
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  5. Sunao Uemura
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  6. Shigehiro Tsujii
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  7. Hiromichi Maeda
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  8. Hiroyuki Kitagawa
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  9. Michiya Kobayashi
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  10. Kazuhiro Hanazaki
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Correspondence to Tsutomu Namikawa.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all patients for being included in the study.

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Namikawa, T., Tsuda, S., Fujisawa, K. et al. Conversion surgery after S-1 plus oxaliplatin combination chemotherapy for advanced gastric cancer with multiple liver metastases. Clin J Gastroenterol 11, 297–301 (2018). https://doi.org/10.1007/s12328-018-0842-8

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  • DOI: https://doi.org/10.1007/s12328-018-0842-8

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