The therapeutic strategy for advanced gastric cancer with pyloric stenosis and liver metastasis; successfully treated by gastro-jejunal bypass and chemotherapy first, followed by curative R0 resection
| Autor: | Toshiyuki Kosuga, Satoshi Mochizuki, Eigo Otsuji, Ayana Yoshioka, Masamichi Bamba, Taiga Yamamoto, Masahiro Tsujiura, Naosuke Nakamichi, Susumu Nakashima, Yoshimi Ouchi, Tomohiro Matsui, Takeshi Ishimoto, Mamoru Masuyama, Hidekazu Hiramoto |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Chemotherapy business.industry Colorectal cancer medicine.medical_treatment lcsh:Surgery Cancer Case Report lcsh:RD1-811 medicine.disease Gastroenterology Pyloric stenosis Metastasis Capecitabine Regimen Bypass surgery Preoperative chemotherapy Gastro-jejunal bypass Internal medicine medicine Gastric cancer business Liver metastasis medicine.drug |
| Zdroj: | Surgical Case Reports Surgical Case Reports, Vol 7, Iss 1, Pp 1-8 (2021) |
| ISSN: | 2198-7793 |
| DOI: | 10.1186/s40792-020-00979-7 |
| Popis: | BackgroundThe indication of surgical resection for liver metastasis from gastric cancer (GC) is still limited and controversial because of its more aggressive oncological characteristics than liver metastasis from colorectal cancer. Pyloric stenosis causes an inadequate oral intake and malnutrition in GC patients. We herein report a case of GC with these two factors that was successfully treated by the combination of gastro-jejunal bypass and chemotherapy, followed by curative R0 resection.Case presentationA 60-year-old man was diagnosed with type 2 GC with liver metastasis and pyloric stenosis, which was confirmed as the HER2-positive type. He underwent gastrojejunostomy and received capecitabine and cisplatin (XP) + trastuzumab chemotherapy. After three courses of the XP + trastuzumab regimen, shrinkage of the primary lesion and liver metastasis was confirmed and his nutritional parameters markedly improved with a stable oral intake after bypass surgery. He underwent curative R0 resection by distal gastrectomy with D2 lymphadenectomy and partial hepatectomy. Histologically, viable tumor cells were observed in less than one-third of the primary lesion, and only scar tissue without viable cancer cells was noted in the resected liver specimen. His postoperative course was uneventful, and recurrence has not been detected in the 30 months after surgery without adjuvant chemotherapy.ConclusionThe present case report describes a successful strategy for advanced GC with pyloric stenosis and liver metastasis. |
| Databáze: | OpenAIRE |
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