Gastric cancer with Virchow's lymph node metastasis (LNM) is not indicated for initial curative surgery. Although there have been some case reports of curative resections after pre-operative treatment, including immune checkpoint inhibitors (ICIs), there is no consensus regarding the optimal timing of surgery. We describe a rare case of initially unresectable gastric cancer treated preoperatively with nivolumab combined chemotherapy, which achieved a pathologically complete response. An 82-year-old man was referred for gastric cancer treatment. Contrast-enhanced computed tomography revealed stomach wall thickening and swollen left supraclavicular LN. This gastric cancer was assessed as unresectable due to the presence of Virchow's LNM; therefore, chemotherapy and ICI using S-1 plus oxaliplatin plus nivolumab were administered. After three courses of treatment, the primary tumor and Virchow's LN showed a marked reduction in size. The patient underwent Virchow's LNM resection as a preliminary step to determine indications for curative surgery. A pathological examination revealed no viable cancer cells were found inside the resected LN. The patient underwent distal gastrectomy. Pathological examination revealed complete degeneration of the primary tumor and regional LN without residual carcinoma. The patient did not receive adjuvant chemotherapy and survived with no evidence of recurrence for one year after the initial treatment.
This study investigated the clinical characteristics of patients with gastric tube cancer following esophagectomy at our hospital, and to examine the outcomes of gastrectomy versus endoscopic submucosal dissection. Of 49 patients who underwent treatment for gastric tube cancer that developed 1 year or more after esophagectomy, 30 patients underwent subsequent gastrectomy (Group A), and 19 patients underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) (Group B). The characteristics and outcomes of these two groups were compared. The interval between esophagectomy and diagnosis of gastric tube cancer ranged from 1 to 30 years. The most common location was the lesser curvature of the lower gastric tube. When the cancer was detected early, EMR or ESD was performed, and the cancer did not recur. In advanced tumors, gastrectomy was performed but the gastric tube was difficult to approach and lymph node dissection was difficult; two patients died as a result of the gastrectomy. In Group A, recurrence occurred most often as axillary lymph node, bone, or liver metastases; in Group B, no recurrence or metastases were observed. In addition to recurrence and metastasis, gastric tube cancer is often observed after esophagectomy. The present findings highlight the importance of early detection of gastric tube cancer after esophagectomy and that the EMR and ESD procedures are safe and have significantly fewer complications compared with gastrectomy. Follow-up examinations should be scheduled with consideration given to the most frequent sites of gastric tube cancer occurrence and the time elapsed since esophagectomy.
Esophageal neuroendocrine carcinoma (ENEC) are rare and aggressive behavior with early dissemination and poor prognosis. According to previous reports, including case reports and reviews, the incidence of ENEC ranges from about 0.8–2.8%. Unfortunately, the rarity of this tumor has not yet permitted the prospective recruitment of patients in clinical trials, in order to establish the optimal therapy. The purpose of this study was to determine the optimal surgical treatment of ENEC. The histological diagnosis of ENEC was determined by examination of surgically resected specimens in patients who underwent surgery. The patients were selected from a prospective study of Department of Surgery, Institute of Gastroenterology Tokyo Women’s Medical University from 1968 to 2021. We study 27 cases of ENEC who performed operation with lymph node dissection. We investigated (1) the patient characteristics, (2) pathological findings including immunohistochemical profiles, (3) recurrence pattern, and survival curves, (4) ki-67 index. This study was approved by the ethics committee of Tokyo Women’s Medical University in Tokyo Japan. (1) gender (mail: female=23: 4), depth (T1: T2; T3: T4)=8: 3: 12: 4 Lymph node (N0: N1)=2: 25 (2) Immunohistochemistry of synaptophysin: chromogranin A: NCAM = 70.4%: 45%: 60% (3) recurrence pattern (liver: lung: Lymph node: bone: dissemination = 8: 6: 4: 2: 4) 50% survival rate (T1: T2-4= 19 months: 6.5 months) p=0.0202, numbers of lymph node (0-2: 3< = 19 months: 4mnths)p<0.001, (4) ki-67 index 82.23%(57.36%-98.71%) Cases in which long-term survival was obtained by surgical treatment was T1 or 0-2 numbers of lymph node. Ki-67 index was more than 80%.
Purpose To evaluate the long-term survival outcomes from our previous study: the phase II study of neoadjuvant chemotherapy with S-1 plus oxaliplatin for cT4 or N2-3 advanced gastric cancer. Methods The patients with clinical T4 and/or N2 or more lymph nodes received two cycles of neoadjuvant chemotherapy with S-1 plus oxaliplatin (oxaliplatin at 130 mg/m2 on day 1 and S-1 at 80–120 mg/day for 2 weeks, q 3 weeks), followed by gastrectomy with D2 lymphadenectomy. The final preplanned analysis of long-term outcomes, including overall and relapse-free survival, was performed. This trial has been completed and registered with the University Hospital Medical Information Network Clinical Trials Registry under number UMIN 000024656. Results Between May 2016 and March 2019, 30 patients were enrolled. All patients could complete the protocol. After a median follow-up of 50 months for surviving patients, the 3-year overall and recurrence-free survival rates were 80.0% and 76.7%, respectively, at the last follow-up in March 2023, whereas the 5-year overall and recurrence-free survival rates were 72.7% and 73.0%, respectively. Conclusion Two cycles of neoadjuvant chemotherapy with S-1 plus oxaliplatin, followed by D2 gastrectomy, was associated with relatively good long-term oncologic outcomes for patients with high-risk gastric cancer.
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