Successful Treatment of Advanced Gastric Adenocarcinoma with Portal Tumor Thrombosis by Total Gastrectomy Following CDDP and S-1 Therapy

Gastric cancers with portal tumor thrombosis (GCPTs) are a rare entity, often concomitant with hematogenous metastases, and chemotherapy is mainly used to treat them. However, the outcome of GCPT is reported to be dismal. We experienced a case of GCPT with splenic metastases. A 53-year-old man was admitted for anorexia. Upper gastrointestinal scope revealed type 3 gastric cancer of the stomach. Abdominal computed tomography showed a huge tumor thrombus in the splenic vein extending to the hepatic hilus and multiple metastases to the spleen. S-1 was given orally from day 1 to day 21 and 60 mg of CDDP was administered intravenously. The cancerous thrombosis in the portal system and splenic metastases disappeared due to chemotherapy. Total gastrectomy with lymphadenectomy and splenectomy was carried out with curative intent after 10 courses of chemotherapy. Intraoperatively, no tumor thrombosis was identified and the gastric tumor was surgically removed. After surgery, the patient received adjuvant chemotherapy of S-1. After 6 months he is well and has not suffered from tumor relapse. A combination of CDDP + S-1 plus intervention surgery seems to be a promising option for GCPT.