Stage IV Gastric Cancer Treated by Curative Surgery after Perforation during Chemotherapy—A Case Report—

Abstract

A 72-year-old patient was diagnosed with advanced type 3 gastric cancer in the middle body of the stomach. Abdominal computed tomography (CT) showed a liver metastasis. The clinical stage was determined to be T3, N1, H1, M1(HEP), and Stage IV. The patient was referred complaining of sudden abdominal pain on day 13 of chemotherapy with S-1 plus oxaliplatin (SOX). Abdominal CT showed intra-abdominal free air and a defect of the gastric wall. Emergent total gastrectomy was performed. The defect of the gastric wall was observed in the ulceration of the gastric cancer. The pathological response was grade 3. The patient was discharged 17 days after surgery and continued the same chemotherapy. The liver metastasis shrank from 42 mm to 11 mm after 8 courses of chemotherapy, and metastasectomy was performed. The patient has survived 8 months after this metastasectomy (16 months from treatment start). The high antitumor effect of chemotherapy may lead to perforation of gastric cancer, and it is necessary to consider the treatment strategy taking into account the possibility of future conversion surgery if the gastric cancer perforates during chemotherapy.