Multi-look staging laparoscopy and conversion surgery for gastric cancer with peritoneal metastases

A 46-year-old male patient with anorexia consulted our hospital. A scirrhous gastric cancer was found, and he was introduced to us. Laparoscopic examination was performed, and advanced peritoneal disseminated nodules were confirmed (CY1, P1). S-1 plus docetaxel therapy was introduced as first-line chemotherapy. Although the best effect judgment was PR, the primary lesion re-increased in size. We changed to the secondary weekly paclitaxel therapy. After 7 courses of the therapy, a second laparoscopic examination was performed, which confirmed the microscopic residual cancer cells (P1) in the reduced peritoneal nodules. Then, we performed 4 courses of intraperitoneal chemotherapy and a third laparoscopic examination. It showed CYO, PO, and we decided to perform conversion surgery. Total gastrectomy with D2 lymph node dissection was performed. The postoperative pathological diagnosis was ypT3N0M0, ypStage II A, and the histological effect judgment was Grade 2. S-1 oral administration was continued for 1 year as an adjuvant therapy, and recurrence was observed for 2 years.