Case Report
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World J Gastroenterol. Sep 14, 2010; 16(34): 4367-4370
Published online Sep 14, 2010. doi: 10.3748/wjg.v16.i34.4367
Gastrojejunostomy followed by induction chemotherapy for incurable gastric cancer with outlet obstruction
Yasuhiro Okumura, Manabu Ohashi, Souya Nunobe, Tomohiro Iwanaga, Tatsuo Kanda, Yoshiaki Iwasaki
Yasuhiro Okumura, Manabu Ohashi, Tomohiro Iwanaga, Yoshiaki Iwasaki, Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan
Souya Nunobe, Department of Gastrointestinal Surgery, Tokyo University Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
Tatsuo Kanda, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
Author contributions: Ohashi M, Nunobe S and Iwasaki Y designed the research; Okumura Y and Ohashi M wrote the paper; Iwanaga T did the clinical work; Kanda T reviewed the paper.
Correspondence to: Manabu Ohashi, MD, PhD, Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan. ohamana@cick.jp
Telephone: +81-3-38232101 Fax: +81-3-38241552
Received: April 7, 2010
Revised: May 14, 2010
Accepted: May 21, 2010
Published online: September 14, 2010
Abstract

A 72-year-old male gastric cancer patient with outlet obstruction underwent laparoscopic exploration. The examination disclosed intraperitoneal free cancer cells with no overt peritoneal, lymphatic, or hepatic metastasis. The patient underwent laparoscopy-assisted gastrojejunostomy (LAGJ) and started chemotherapy with S-1 plus cisplatin on postoperative day 13. Three course of the chemotherapy shrank the tumor markedly. Then, the patient underwent gastrectomy with a curative intent. Laparotomy revealed no intraperitoneal free cancer cells, and microscopically complete resection was achieved. The patient received S-1 chemotherapy as postoperative adjuvant treatment for 1 year, and is still alive with no evidence of peritoneal recurrence. LAGJ followed by S-1 plus cisplatin is one of the optional treatments that should be considered for patients with outlet obstruction as it may widen opportunities for potentially curative resection.

Keywords: Gastric cancer; Outlet obstruction; CY1; Laparoscopy-assisted gastrojejunostomy; S-1 plus cisplatin