Abstract
A 72-year-old man who exhibited Borrmann type 2 gastric cancer with metastases in the liver and paraaortic lymph nodes underwent total gastrectomy with D4 lymph node dissection, distal pancreaticosplenectomy, and partial resection of the two metastatic liver tumors. The para-aortic nodal metastases were not completely dissected, and resulted in noncurative resection. However, a catheter for hepatic arterial infusion was inserted. The resected cancer was histologically diagnosed as poorly differentiated adenocarcinoma, ssγ, ly3, v1, and n4. For early postoperative chemotherapy, the patient was treated with hepatic arterial infusion (750mg of 5-FU, 10mg of adriamycin, and 26mg of mitomycin C), oral doxifluridine (600mg/day), and intravenous infusion of cisplatin (100mg), mitomycin C (48mg), etoposide (150mg) and pirarubicin (60mg). Administrations of oral tegafur (600mg/day) and intravenous lentinan (2mg/2 weeks) were continued at an outpatient clinic. At 1 year and 6 months after the operation, residual metastases in the para-aortic lymph node were not detected by abdominal computed tomography, and complete response continued for 5 months. Therafter, the tegafur-lentinan therapy was continued, the patient remained in good general condition, and the values of both carcinoembryonic antigen and immunosuppressive acidic protein in the serum normal until 4 years and 6 months after the operation. He died of mediastinal lymph node recurrence 5 years and 2 months after the operation, but no hepatic recurrence was detected. Thus, the patient was successfully treated by the maintaining immunochemotherapy, as well as cytoreductive surgery and early postoperative induction chemotherapy, which resulted in long-term survival.
