A case report of advanced gastric adenocarcinoma with peritoneal seedings which responded to systemic chemotherapy and became surgically respectable

Abstract

A 45-year-old man was hospitalized because of incapability of taking food by mouth due to abdominal distention. On admission an upper gastrointestinal endoscopy demonstrated gastric cancer of type 3. Abdominal CT scans revealed the presence of massive ascites. A cytological examination detected Class V. Consequently, under a diagnosis of Stage IV gastric cancer, the patient received single agent chemotherapy with TS-1. The primary cancer was reduced in size with disappearance of ascites after 5 months. Because laparoscopy demonstrated neither ascites nor any peritoneal metastasis, this patient underwent a total gastrectomy by laparotomy. Intraoperative washing cytology was also negative for tumor cells. With the surgical specimen, the cancer, remaining confined to ss, was at stages of N2 and P0. The chance of cure after the curative resection was estimated as B.
This is a report of a case in which we achieved a successful curative resection of gastric cancer with peritoneal seedings, which had been reduced in size with disappearance of ascites by oral chemotherapy with a single agent TS-1 alone and hence, had become surgically resectable. Chemotherapy, but not surgery, is the current standard treatment for advanced gastric cancer associated with peritoneal seedings because surgical resection has not significantly improved the prognosis of such advanced gastric cancer. The progress in anticancer agents has made gastric cancer chemosensitive although seldom. Consequently, neoadjuvant chemotherapy should be considered as a choice of therapeutic modalities even if gastric cancer has advanced to Stage IV.