[A Case of Conversion Surgery after Long-Term Chemotherapy for Advanced Gastric Carcinoma with Synchronous Distant...

We report the case of a patient who underwent conversion surgery after long-term chemotherapy for advanced gastric carcinoma with synchronous distant metastasis. She was admitted to our hospital because of back pain and elevated serum ALP level. Gastrointestinal endoscopy showed multiple 0-Ⅱa like lesions at the gastric antrum, and a biopsy specimen showed poorly differentiated adenocarcinoma negative for HER2. Colonoscopy showed a submucosal tumor at the cecum, and pathological examination revealed metastatic gastric adenocarcinoma. CT revealed regional lymph node metastasis, bilateral ovarian tumors, and systemic bone absorption indicating metastasis. Systemic chemotherapy with cisplatin and S-1 was carried out, and complete resolution of gastric and colic lesions was obtained. Afterwards, a new gastric lesion appeared with re-growth of regional lymph nodes and bilateral ovarian tumors. Distal gastrectomy with D2 dissection and bilateral ovariectomy was performed 2 years 6 months after the initial therapy. Although systemic chemotherapy is the standard treatment for advanced gastric carcinoma with distant metastasis, surgical resection can be justified when drug-resistant lesions are localized and conversion surgery is feasible. Postoperative chemotherapy is mandatory to prolong survival.