The case was a 70s-year-old man. In July 2016, he was admitted to our hospital with a complaint of epigastralgia. Upper gastrointestinal endoscopy revealed type 3 advanced
gastric cancer in the vestibule, directly infiltrating the pancreas and the left lobe of the liver to form an
abscess, and swelling of the aortic lymph node and multiple liver
metastases were observed. The
cancer was diagnosed as cT4b(liver/pancreas), N2M1(H1P0CYX), cStage IV and diagnosed it as a
chemotherapy policy. We initiated SOX plus
trastuzumab therapy from August 2016. After 4 courses, the primary
tumor shrunk significantly and invasion to the pancreas/liver had disappeared. Furthermore, the periarterial lymph node and multiple liver
metastases were obscured(
chemotherapy effect judgment: PR). With a diagnosis of ycT4aN1MX(HXP0CYX), in December 2016, we performed a pyloric side
gastrectomy D2(+No.16)dissection and partial resection of the liver(S3, S4, S6), liver RFA(S4, S6, S7). Due to recent progress in
chemotherapy and multidisciplinary
therapy, there is a possibility that radical resection may be carried out for advanced
gastric cancer, which was previously unresectable, by performing a treatment with surgery in mind.