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Case Reports
, 7 (4), 482-488

Endoscopic Resection for Residual Lesion of Metastatic Gastric Cancer: A Case Report

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Case Reports

Endoscopic Resection for Residual Lesion of Metastatic Gastric Cancer: A Case Report

Kaori Hayashi et al. World J Clin Cases.

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: Case report; Chemotherapy; Conversion; Endoscopic submucosal dissection; Gastric cancer; Liver metastases.

Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Objective image findings at the first visit to our institute. A: EGD findings before treatment. EGD found a protruding lesion, 20 mm in diameter, at the gastric cardia; B: Abdominal CT with contrast before treatment; CT showed multiple mass lesions throughout the liver (arrows). EGD: Esophagogastroduodenoscopy; CT: Computed tomography.
Figure 2
Figure 2
Objective image findings after chemotherapy. A: EGD finding after chemotherapy. The lesion became unclear. It appeared smooth and protruded, and looked like a submucosal tumor; B: Abdominal CT with contrast after chemotherapy showed multiple lesions had disappeared and no evidence of disease in the liver. EGD: Esophagogastroduodenoscopy; CT: Computed tomography.
Figure 3
Figure 3
Result of gastric submucosal dissection. A: Macroscopic findings from a resected specimen; B: Histopathological result of a resected specimen: 28 mm × 12 mm, U, type 0-IIc, 1.0 mm × 1.0 mm, well-differentiated tubular adenocarcinoma (tub1), ypT1b, ly0, v0, pHM(-), and pVM(-).

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