2012 Volume 45 Issue 3 Pages 258-266
We report a case of advanced gastric cancer with para-aortic lymph node metastasis that underwent radical gastrectomy after neoadjuvant chemotherapy, and in this case, thoracoscopy was useful in excluding mediastinal lymph node metastasis. The patient was a 70-year-old man in whom a large type 2 advanced gastric cancer accompanied with para-aortic and mediastinal lymph node metastasis was diagnosed. We attempted combination therapy of Docetaxel, CDDP and TS-1. After 2 courses of treatment, the primary lesion and regional and para-aortic lymph nodes were significantly reduced in size, suggesting that this therapy had induced a partial response (PR). However, the size of mediastinal lymph node did not change. FDG-PET showed accumulation of FDG located in the mediastinal lymph node, in which metastasis was suspected. To judge the possibility of radical excision, we performed thoracoscopic biopsy of the mediastinal lymph node. No metastasis was shown in the mediastinal lymph node biopsy, so we performed curative total gastrectomy with D3 lymph node dissection and cholecystectomy with curative intent. The pathological findings showed that there were very few cancer cells either in the primary lesion and only one lymph node (No.3). There has been no recurrence for two years after the operation.
