2025 Volume 58 Issue 2 Pages 75-85
A 62-year-old man with positive secondary screening was diagnosed with unresectable advanced gastric cancer with a tumor thrombus in the superior mesenteric vein (SMV). A total of 10 courses of systemic chemotherapy were administered and the tumor thrombus was reduced, but still persisted. The patient was unable to continue chemotherapy due to adverse events and underwent conversion surgery of standard gastrectomy with removal of the tumor thrombus. In the surgery, an approach could be made from the SMV to the portal vein with preservation of the pancreas. The thrombus was sclerotic and adherent, so the SMV was resected and revascularized with a left femoral vein graft. Pathologically, the diagnosis was complete response and all tumor thrombi were fibrotic with no residual tumor. The postoperative course was good and the patient has survived without recurrence to date.
