Conversion Surgery for a Patient with cStage IV Gastric Cancer with Para-Aortic Lymphatic Metastases Who Achieved a Complete Pathological Response after First Line Nivolumab Plus Tegafur-Gimeracil-Oteracil/Oxaliplatin Therapy

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  • Nozu Shintaro
    First Department of Surgery, Yamagata University Faculty of Medicine
  • Musha Hiroaki
    First Department of Surgery, Yamagata University Faculty of Medicine
  • Yamaga Ryosuke
    First Department of Surgery, Yamagata University Faculty of Medicine
  • Suzuki Takefumi
    First Department of Surgery, Yamagata University Faculty of Medicine
  • Kamio Yukinori
    First Department of Surgery, Yamagata University Faculty of Medicine
  • Motoi Fuyuhiko
    First Department of Surgery, Yamagata University Faculty of Medicine
  • Kitaoka Takumi
    Department of Pathology, Yamagata University Faculty of Medicine

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  • 傍大動脈リンパ節転移を伴うStage IV胃癌に対しnivolumab+tegafur-gimeracil-oteracil/oxaliplatin療法後conversion surgeryを施行し病理学的完全奏効を得た1例

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<p>A 71-year-old man was diagnosed with swelling of the para-aortic lymph nodes on CT performed for evaluation of disc herniation. Esophagogastroduodenoscopy (EGD) revealed a type 2 tumor in the gastric antrum, and biopsy showed moderately to poorly differentiated adenocarcinoma. The patient was diagnosed with clinical Stage IV gastric cancer with metastases to para-aortic lymph nodes (Nos. 16a2 lat, 16b1 lat). First line nivolumab (Nivo) plus tegafur-gimeracil-oteracil/oxaliplatin (SOX) therapy was administered. After 3 courses of immunochemotherapy, CT revealed shrinkage of almost all of the metastatic lymph nodes. Furthermore, EGD revealed that the primary tumor had become scarred, and biopsy showed non-neoplastic tissue. We judged that curative resection was possible, and distal gastrectomy D2 lymph node dissection, para-aortic lymph node dissection, and Billroth I reconstruction were performed. The patient was discharged 12 days after surgery without complications. The histological effect was complete response. Herein, we describe a patient with gastric cancer who was successfully treated with first line Nivo plus SOX therapy followed by conversion surgery who achieved a pathological complete response.</p>

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