Successful Management of Advanced Gastric Cancer With Bulky Lymph Node Metastases and Tumor Thrombus in the Portal Vein System: A Case Report

Abstract

Background: Gastric cancer cases with tumor thrombus in the portal vein system (PVTT) are rare, frequently develop liver metastasis, and have a very poor prognosis. Case presentation: A 65-year-old man presented to a physician with a complaint of upper abdominal pain persisting for 2 months. Esophagogastroduodenoscopy revealed a Borrmann type 2 tumor, and he was referred to our hospital. Computed tomography (CT) showed wall thickening of the stomach, bulky swelling of lymph nodes in the lesser curvature and along the pancreas body, and tumor thrombus in the splenic to the portal vein. CT showed no liver or lung metastases, ascites, or peritoneal nodules. Staging laparoscopy revealed P0CY0. We planned to administer neoadjuvant chemotherapy (NAC), consisting of 2 courses of TS-1 and cisplatin combined chemotherapy. However, the second course of the chemotherapy was canceled on day 8 because of influenza. CT after chemotherapy showed no remarkable change, but we decided to undertake the planned operation. Total gastrectomy and pancreaticosplenectomy, along with lymphadenectomy, thrombectomy, and cholecystectomy, was performed. The patient was discharged on postoperative day 12 without complications. Histopathologic examination showed a well to moderately differentiated adenocarcinoma with 45 lymph node metastases. The specimen of the tumor thrombus also showed a moderately differentiated adenocarcinoma. Because he did not want additional chemotherapy, we selected follow-up observation. The patient has remained disease-free for 60 months after the operation. Conclusion: We described a patient with advanced gastric cancer with PVTT, who could undergo R0 resection with a good clinical course.