PDF(Pubmed)
Abstract：
While the importance of conversion surgery has increased with the development of systemic chemotherapy for gastric cancer (GC), reports of conversion surgery for patients with GC with distant metastasis and tumor thrombus are extremely scarce, and a definitive surgical strategy has yet to be established. Herein, we report a 67-year-old man with left abdominal pain referred to our hospital following a diagnosis of unresectable GC. Esophagogastroduodenoscopy and contrast-enhanced abdominal computed tomography (CT) revealed advanced GC with splenic metastasis. A splenic vein tumor thrombus (SVTT) and a continuous thrombus to the main trunk of the portal vein were detected. The patient was treated with anticoagulation therapy and systemic chemotherapy comprising S-1 and oxaliplatin. One year following chemotherapy initiation, a CT scan revealed progressive disease (PD); therefore, the chemotherapy regimen was switched to ramucirumab with paclitaxel. After 10 courses of chemotherapy resulting in primary tumor and SVTT shrinkage, the patient underwent laparoscopic total gastrectomy (LTG) and distal pancreaticosplenectomy (DPS). He was discharged without complications and remained alive 6 months postoperatively without recurrence. In summary, the wait-and-see approach was effective in a patient with GC with splenic metastasis and SVTT, ultimately leading to an R0 resection performed via LTG and DPS.
摘要：
虽然随着胃癌（GC）全身化疗的发展，转换手术的重要性增加，对于有远处转移和癌栓的GC患者进行转换手术的报道极为罕见，并且尚未建立明确的手术策略。在这里，我们报告了一名67岁的左腹痛患者，他在诊断为无法切除的GC后转诊至我们医院。食管胃十二指肠镜检查和对比增强腹部计算机断层扫描（CT）显示晚期GC伴脾转移。检测到脾静脉肿瘤血栓（SVTT）和门静脉主干的连续血栓。患者接受抗凝治疗和包括S-1和奥沙利铂的全身化疗。化疗开始一年后，CT扫描显示进行性疾病（PD）；因此，化疗方案改为雷莫西单抗联合紫杉醇.化疗10个疗程后导致原发肿瘤和SVTT缩小，患者接受了腹腔镜全胃切除术(LTG)和远端胰脾切除术(DPS).他出院，无并发症，术后6个月存活，无复发。总之,等待观察方法对患有脾转移和SVTT的GC患者有效，最终导致通过LTG和DPS进行R0切除。
