Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2019; 7(4): 482-488
Published online Feb 26, 2019. doi: 10.12998/wjcc.v7.i4.482
Endoscopic resection for residual lesion of metastatic gastric cancer: A case report
Kaori Hayashi, Sho Suzuki, Hisatomo Ikehara, Hiroaki Okuno, Akira Irie, Mitsuru Esaki, Chika Kusano, Takuji Gotoda, Mitsuhiko Moriyama
Kaori Hayashi, Sho Suzuki, Hisatomo Ikehara, Hiroaki Okuno, Akira Irie, Mitsuru Esaki, Chika Kusano, Takuji Gotoda, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Chiyoda-ku 1018309, Japan
Author contributions: Hayashi K, Suzuki S, Ikehara H, Okuno H, Irie A, Esaki M, Kusano C, Gotoda T, Moriyama M wrote the paper.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist-2016.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sho Suzuki, MD, PhD, Doctor, Research Associate, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Tokyo, Chiyoda-ku 1018309, Japan. s.sho.salubriter.mail@gmail.com
Telephone: +81-3-32931711 Fax: +81-3-32922880
Received: October 29, 2018
Peer-review started: October 29, 2018
First decision: November 27, 2018
Revised: December 25, 2018
Accepted: January 8, 2019
Article in press: January 8, 2019
Published online: February 26, 2019
Abstract
BACKGROUND

Chemotherapy is a standard strategy for stage IV gastric cancer patients. However, some cases cannot undergo conversion surgery because of their frailty, even if the patients had response to chemotherapy. For these patients, local tumor progression is a problem. We report here the case of a patient whose residual gastric cancer was resected through endoscopic submucosal dissection (ESD) after concomitant chemotherapy for metastatic gastric cancer.

CASE SUMMARY

An 85-year-old male complained of difficulty swallowing, and examination revealed gastric cancer with multiple liver metastases. Although he received concomitant chemotherapy, a residual tumor was observed in the primary lesion while the metastatic lesions disappeared completely. Conversion surgery was considered optional treatment; however, he could not undergo that because of advanced age and comorbidities. Thus, we performed ESD to treat the residual tumor. As a result, we resected the residual lesion completely. The patient has been alive for 29 mo since ESD, without recurrence.

CONCLUSION

We achieved local control using ESD, and these findings may provide therapeutic improvements both in local control and patient survival outcomes.

Keywords: Gastric cancer, Liver metastases, Conversion, Endoscopic submucosal dissection, Chemotherapy, Case report

Core tip: Some cases cannot undergo conversion surgery because of their frailty, even if the patients had response to chemotherapy. For these patients, local tumor progression is a problem. We resected a residual tumor completely using endoscopic submucosal dissection (ESD) after chemotherapy in an elderly patient who was unable to undergo conversion surgery due to his age and comorbidities. The patient has been alive without recurrence for 29 mo after the ESD. ESD may provide therapeutic improvements in both local control and patient survival outcomes.