Successful Conversion Surgery for Unresectable Gastric Cancer with Tumor Thrombus in the Portal Vein

Abstract

An 80-year-old man with performance status (PS) 0 who presented with hyperthermia, abdominal pain, and abnormal liver function following a blood examination was diagnosed with type 3 gastric cancer and obstructive cholangitis caused by giant tumor thrombus in the portal vein with obstruction. Biopsy of the gastric tumor yielded a diagnosis of papillary adenocarcinoma with HER2-positive expression. After treatment of cholangitis, he received combination chemotherapy with capecitabine, oxaliplatin, and trastuzumab. After 13 cycles of chemotherapy, the primary tumor was markedly reduced in size, and the portal vein tumor thrombus disappeared. Therefore, total gastrectomy with D2 lymph node dissection as conversion surgery was performed. Operation time was 317 minutes, and blood loss was 324 ml. He was discharged on postoperative day 30 with no complications. S-1 was administered as adjuvant chemotherapy. He is alive without evidence of recurrence 30 months after surgery.