ABSTRACT
Background: Remnant gastric cancer (RGC) refers to carcinoma of the residual stomach occurring after gastrectomy. With an incidence of 1-7%, it is believed to have a different disease mechanism and a poorer prognosis than primary gastric cancer (PGC). However, due tu its rarity, the standard treatment for RGC remains undefined. Therefore, the multidisciplinary/tailored approach becomes crucial for the treatment of these patients. Materials and Methods: We present the case of a 64 years old male patient with family history of GC (father) and personal history of distal gastrectomy for peptic disease with Billroth-II reconstruction in 1979, orchiectomy for pT1 seminoma in 2017, and COPD. During follow-up for his seminoma the patient was diagnosed with clinical stage III intestinal type G1 gastric adenocarcinoma. The case was presented to our multidisciplinary team meeting (MDTm) and neoadjuvant treatment (FLOTx4) was started. In november 2019 an exploratory laparotomy was performed finding a RGC of the lesser curvature infiltrating the pancreas, the surgical team decided not to perform resection. The case was again presented in our MDTm and FLOT Protocol was completed (x4 cicles). CT scan showed good response and new laparotomy was planned. However, due to SARS-CoV2 outbreak the patient could not be operated on and was presented again to MDTm, deciding to proceed with chemoradiotherapy (50Gy + Taxol + CBP for 6 weeks). After the outbreak a new laparotomy was performed and a subtotal (95%) gastrectomy + Roux-n-Y reconstruction was performed. Results: After a period of 2 weeks in ICU due to aspiration pneumonia the patient recovered well and was discharged 23 days after surgery. Pathological report showed complete pathological response (grade 0) ypT0ypN0. The patient is currently well and will under surveillance. Conclusions: Although not as frequent as PGC, RGC is a disease with poor prognosis due to its diagnosis at advanced stages and the lack of standard treatment in current guidelines for both systemic and surgical treatment. In this setting, the role of MDTs and tailored treatments can contribute to both short- and long-term oncological outcomes and patient’s quality of life. In this case, FLOT followed by chemoradiotherapy (50Gy + Taxol + Carboplatinum) for 6 weeks, followed by subtotal gastrectomy allowed us to achieve a complete pathological response. Eventhough these results need further research, this could be a good treatment option in selected patients.