[A Case of Advanced Gastric Cancer with Radical Para-Aortic Lymph Node Dissection Following Gastric-Jejunal Bypass for Pyloric Stenosis and Preoperative Chemotherapy].

Abstract

The patient was a man in his 60s who complained of gastric reflux and was diagnosed with advanced gastric cancer (tub1, por1)involving pyloric stenosis. Computed tomography revealed an enlarged para-aortic lymph node(PALN, #16a2). His preoperative diagnosis was cT4aN2M1(LYM), cStage Ⅳb. The patient underwent laparoscopic gastric jejunal bypass surgery to treat the pyloric obstruction and was administered 2 courses of preoperative chemotherapy with S-1+L-OHP(SOX). Significant shrinkage was observed in both the primary tumor and surrounding lymph node metastases, and the PALN did not exhibit further enlargement. Therefore, the patient was eligible for surgery. Intraoperative diagnosis of PALN#16a2 was positive for metastasis, and distal gastrectomy with radical para-aorticlymph node dissection(#16a2+b1)was performed. The gastric jejunal bypass was preserved for reconstruction, and the pathological diagnosis was ypT2N3(15/60). Following discharge, adjuvant chemotherapy with S-1+DTX(DS)was performed for 1 year, and no recurrence has been observed for 1 year and 6 months. This study showed that advanced gastric cancer with pyloric stenosis and PALN enlargement can be treated with radical para-aortic lymph node dissection through prompt introduction of preoperative chemotherapy following gastric jejunostomy bypass surgery.