Abstract
A 62-year-old man was admitted with epigastralgia and trembling. Abdominal enhanced CT scan showed that the wall thickening in the upper gastric lesion together with free air and ascites. As perforation of advanced gastric cancer was suspected, an emergency surgery was performed. Then it found out that gastric tumor had invaded esophageal-gastric junction and diaphragm, and perforation site was located at the anterior wall of the upper part of gastric body. Since primary curative resection was impossible, jejunostomy was performed for treatment and nutritional control. On examination after primary surgery, Biopsies taken from that lesion revealed poorly differentiated adenocarcinoma. Diagnosed with unresectable advanced gastric cancer and treated with S-1 and CDDP combination chemotherapy. S-1 was administered through the jejunal tube, which decreased the size of the primary tumor and lymph node metastases after 2 courses, total gastrectomy (D2) and splenectomy were performed. The final diagnosis was Stage Ⅳ and the pathological response to chemotherapy was Grade 2. This concludes that the administration of S-1 through jejunostomy combined with CDDP may be effective in patients who are unable to ingest oral medication due to the obstruction with unresectable advanced gastric cancer. We present this rare case with a review of the literature.
