Surgical Resection First for Localized Gastric Adenocarcinoma: Are There Adjuvant Options?
Surgical Resection First for Localized Gastric Adenocarcinoma: Are There Adjuvant Options?
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DOI：
10.1200/jco.2014.60.1765
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发表时间：
2015-10-01
影响因子：
45.3
通讯作者：
Ajani, Jaffer A.
中科院分区：
文献类型：
--
作者：
Elimova, Elena;Ajani, Jaffer A.
A 55-year-old male presented with upper abdominal bloating followed by modest hematemesis that led to the diagnosis of an ulcerated poorly differentiated (with signet ring cells) adenocarcioma in the angularis of the stomach. A contrast-enhanced positron emission tomography (PET) with computed tomography (CT) scan showed higher-than-normal physiologic avidity (standardized uptake value, 4.3) in the proximal stomach but not in the lower stomach, and the CT scan vaguely suggested a polypoid lesion in the distal stomach (Fig IA). Nodes were normal in size, and there were no metastases. He underwent esophagoduodenoscopy with ultrasonography (EUS) that showed a 3- X 2-cm flat nodular mass with an 8-mm ulcer in the angularis (Fig 1B). The tumor mass was demarcated well on narrow-band imaging (Fig 1C), and with a 20-MHz EUS probe, it was designated eusT1bN0 (Fig ID). His case was presented to our weekly Multidisciplinary Gastric Adenocarcinoma Conference, and the consensus was to offer surgery as primary therapy. He underwent a subtotal gastrectomy with Roux-en-Y gastrojejunostomy along with D2 nodal dissection. The surgical pathology showed a poorly differentiated adenocardnoma with signet ringed's; the primarytumor measured 2.8 X 2.2 cm in diameter with infiltration through the muscularis propria and into the subserosal fat. Seven of 53 examined lymph nodes were malignant; therefore, his cancer was staged pT3N3M0 (a higher stage than designated clinically). He recovered well without complications, and the postoperative CT scans showed no metastases. His case was represented at the tumor board meeting, and adjuvant chemotherapy with oxaliplatin and capecitabine was recommended.
