Laparoscopic Gastrectomy for Gastric Cancer with Peritoneal Dissemination after Induction Chemotherapy
A 53-year-old man had difficulty in swallowing. He underwent examination using a gastro fiberscope and was diagnosed with type 4 gastric cancer. A detailed examination of the patient was performed and included a CT scan, 18F-fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT) and a barium meal; the final diagnosis was c stage IV (cT4aN3M0) gastric cancer. Peritoneal dissemination was suspected using FDG PET-CT, and consequently staging laparoscopy was performed. Peritoneal dissemination was confirmed (fig. ). With regard to induction chemotherapy, since HER2 was positive (3+), trastuzumab (first cycle 8 mg/kg, after two cycles 6 mg/kg on day 1) plus capecitabine (2,000 mg/m2 on days 1–14) combined with cisplatin (80 mg/m2 on day 1) was administered. After chemotherapy, we judged that the original tumor was resectable and that dissemination had disappeared on imaging, and we performed staging laparoscopy for a second time. Since peritoneal dissemination was not found during the second staging laparoscopy (fig. ), we carried out TLTG []. The patient commenced meal intake on the third day after the operation and was discharged 10 days later without complications. Adjuvant chemotherapy was initiated 21 days after surgery. To date, we have followed up this patient for 16 months after surgery and there has been no cancer recurrence.