Modified Devine exclusion for unresectable gastric cancer: a bridge from palliative to curative treatment

Progressive advances in cytotoxic systemic therapy have significantly improved survival and quality of life in oncology, particularly in gastric carcinoma, allowing the reconsideration of surgical strategies for patient benefit. We present a case of a female patient in her 70s with locally advanced, unresectable gastric carcinoma causing malignant gastric outlet obstruction syndrome, without metastasis. Following multidisciplinary discussion, the patient underwent palliative partial stomach-partitioning gastrojejunostomy and systemic therapy with the EOX regimen. At 12 months, the patient showed sustained clinical, biochemical and radiological responses, maintaining good nutritional status and quality of life. This led to curative intent surgery, during which the tumour was resectable without multiorgan involvement. A subtotal gastrectomy with D2 lymphadenectomy was performed. Pathology confirmed a tubular gastric adenocarcinoma (ypT2N0, R0). Five years postresection, the patient remains disease-free, with excellent general health, good nutrition and quality of life.