[A Case of Advanced Gastric Cancer with Postoperative Multiple Metastasis, That Obtained Long-Term Survival after Multimodal Therapy].

An 82-year-old female was referred of vomiting and diagnosed with advanced gastric cancer accompanied by pyloric stenosis, with enlarged lymph nodes below the pylorus. After undergoing laparoscopic gastrojejunostomy, 3 courses of S-1 plus L-OHP was administered. Both the lymph nodes and the primary tumor shrank. The patient was diagnosed as ycT4aN2M0, ycStage Ⅲ. Laparoscopic distal gastrectomy were performed. The pathological diagnosis was ypT4aN1M0, ypStage ⅢA. Four courses of S-1 plus L-OHP were administered as postoperative adjuvant chemotherapy, but multiple liver metastases were detected. Because of HER2 negative, 2 courses of ramucirumab plus paclitaxel was administered, but lung metastasis, increased liver metastasis, and ascites were detected. Nivolumab was administered, leading to a reduction in pulmonary nodules, liver metastasis, and ascites. Sixty-five months post-surgery, radiation therapy was administered for recurrent mediastinal lymph node metastasis, achieving significant shrinkage. Nivolumab treatment was continued, and there has been no further disease progression at 83 months post-surgery. This case shows that disease control was achieved with nivolumab for liver, lung, and lymph node metastases following gastric cancer surgery, and long-term survival was attained with multimodal therapy.