[Advanced gastric cancer(Stage IV)leading to perforation during chemotherapy with S-1 plus cisplatin]

A 60-year-old man was diagnosed with advanced gastric cancer(Type 3)with multiple liver and lymph node metastases. The clinical stage was determined to be T3(SS), N2, M1, P0, H1, Stage IV, and a chemotherapy regimen of S-1 plus cisplatin (CDDP)was selected for treatment. During 3 courses of chemotherapy, the patient complained of severe abdominal pain, and an urgent laparotomy was performed with a tentative diagnosis of perforated gastric cancer. Surgical findings revealed a 5-mm perforation in the upper part of the anterior wall of the stomach, from the center of the tumor. Although we detected a metastasis only in S6 of the liver, we decided to perform total gastrectomy, D1 lymphadenectomy, and Roux-en-Y reconstruction. Pathological findings demonstrated that cancer cells were replaced by fibrosis, and tumor response after treatment was determined to be Grade 2. No lymph node metastasis was observed. The patient received chemotherapy with S-1 4 weeks after the operation, without any perioperative complications. The patient is alive 12 months after the operation, without any enlargement of the liver metastasis.