Unresectable Advanced Gastric Cancer with Skin Invasion followed by Total Gastrectomy after Second-Line Chemotherapy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Oncology

Background:

• Locally advanced gastric cancer (LAGC) poses challenges for curative treatment.
• Conversion surgery after chemotherapy for unresectable LAGC is rarely reported with R0 resection.
• This case addresses the feasibility of achieving R0 resection in a patient with unresectable LAGC after second-line chemotherapy.

Observation:

• A 77-year-old male diagnosed with unresectable, locally advanced gastric cancer (cT4 [Skin, Liver] N0M0, Stage IIIA) with skin and liver invasion.
• Initial S-1+CDDP (SP) therapy resulted in partial response (PR), followed by progressive disease (PD).
• Second-line Ramucirumab+Paclitaxel (RAM/PTX) therapy also achieved PR.

Findings:

• The patient underwent successful total gastrectomy with D2 lymph node dissection, Roux-en-Y reconstruction, and resection of invaded skin and liver (R0 resection).
• Postoperatively, the patient remains alive without recurrence at 30 months.
• This demonstrates the potential for conversion surgery in selected LAGC patients after multi-line chemotherapy.

Implications:

• This case highlights the potential role of second-line chemotherapy in converting unresectable gastric cancer to a resectable state.
• Achieving R0 resection in advanced gastric cancer can lead to long-term survival.
• Further research into neoadjuvant chemotherapy regimens for unresectable gastric cancer is warranted.