Abstract：
We report a case in which a patient with advanced gastric cancer with liver metastasis and bulky N showed marked tumor shrinkage with chemotherapy, and underwent conversion surgery. A 77-year-old male. Patient was referred to our department because of advanced gastric cancer. Upper gastrointestinal endoscopy revealed type 2 advanced cancer in the posterior wall of the gastric antrum. Abdominal CT showed thickening of the gastric wall in the same region and bulky lymph node enlargement and para-aortic lymphadenopathy behind the stomach. Staging laparoscopy showed the primary tumor and bulky lymph nodes forming a single mass, invading the pancreas, jejunum, and mesentery, and a solitary mass in the hepatic S3. Biopsy pathology revealed adenocarcinoma. We diagnosed the advanced gastric cancer cT4b(pancreas, jejunum), N2M1 (LYM, HEP), P0CY0, Stage ⅣB. After 2 courses of systemic chemotherapy FOLFOX/nivolumab, total gastrectomy, D2 node dissection, splenectomy pancreas tail resection, cholecystectomy, hepatic resection, partial transverse colon resection, partial jejunum resection, Roux-en-Y reconstruction. R0 resection was performed. The operative time was 620 minutes and blood loss was 1,025 mL. Pathologically, the patient was diagnosed with hepatoid adenocarcinoma, ypT4bN1M1(LYM, HEP), ypStage Ⅳ. The pathological efficacy evaluation was Grade 1a in the primary tumor. The patient has been recurrence-free for 9 months since the initial diagnosis.
摘要：
我们报告了一例晚期胃癌肝转移和大N患者化疗后出现明显的肿瘤缩小，并接受了转换手术。一个77岁的男性。由于晚期胃癌，患者被转诊到我们部门。上消化道内镜显示胃窦后壁2型晚期癌。腹部CT显示相同区域的胃壁增厚，胃后面的大淋巴结肿大和主动脉旁淋巴结病。分期腹腔镜检查显示原发肿瘤和庞大的淋巴结形成一个肿块，侵入胰腺,空肠,和肠系膜,和肝脏S3中的孤立肿块。活检病理提示腺癌。我们诊断为晚期胃癌cT4b(胰腺，空肠),N2M1(LYM,HEP),P0CY0，ⅣB期。经过2个疗程的全身化疗FOLFOX/nivolumab，全胃切除术,D2节点解剖,脾切除胰尾切除,胆囊切除术,肝切除术,部分横结肠切除术,部分空肠切除,Roux-en-Y重建。进行R0切除。手术时间为620分钟，失血量为1,025mL。病理上,病人被诊断为肝样腺癌,ypT4bN1M1(LYM,HEP),ypStageⅣ.原发肿瘤病理疗效评价为1a级。自最初诊断以来，患者已经9个月没有复发。
