Successful Conversion Surgery following Chemotherapy with Nivolumab for Advanced Gastric Cancer with Metastases of Para-aortic and Virchow's Lymph Nodes—A Case Report—

Abstract

A 73-year-old man presented with weight loss and discomfort in the epigastric region. The results of endoscopic examination revealed a type 4 tumor extending from the gastroesophageal region to the gastric antrum. The biopsy results showed poorly differentiated adenocarcinoma, HER2-negative, and CPS≥5. Computed tomography showed metastases to the para-aortic (No.16a2/b1) and Virchow's lymph nodes, in addition to the regional lymph node, resulting in a diagnosis of clinical Stage IVB (cT4aN2M1 (LYM) ). Therefore, capeOX and nivolumab therapy was initiated. All the enlarged lymph nodes disappeared after 10 courses of chemotherapy, and R0 resection was considered possible. However, total gastrectomy with splenectomy and D2+No.10 dissection were performed after 23 courses of chemotherapy considering the difficulty of completing adjuvant chemotherapy. As a result, R0 resection was accomplished, and the pathological result was a complete response ; adjuvant chemotherapy was not administered. Multiple bone metastases were detected 1 year after surgery, and the patient underwent chemotherapy.

Conversion surgery has issues that need to be resolved, such as case selection, timing of surgery, extent of lymph node dissection, and the need for adjuvant chemotherapy.