New strategy in hemorrhagic gastric cancer: A case report of complete pathological remission after neoadjuvant chemotherapy

Abstract

Rationale: Strategy for hemorrhagic gastric cancer should both handle the potential life-threatening situation caused by bleeding and increase probability of long-term survival. For hemorrhagic patients with locally advanced gastric cancer, surgical resection is always the preferred option for the reason that it eliminates both the tumor and risk of rebleeding. However, the long-term survival after resection is still unsatisfactory. Patient concerns: Here, we report a patient with hemorrhagic locally advanced gastric cancer achieved pathological complete response after neoadjuvant chemotherapy. Diagnoses: In this case, a 58-year-old man presenting with gastrointestinal hemorrhage and hemodynamic instability was admitted to the emergency department. Gastroscopy and biopsy revealed a large hemorrhagic ulcerated carcinoma located in the antrum, gastric angle, and lower part of gastric body. Abdominal CT indicated an infiltrative ulcerated carcinoma with perigastric lymph nodes metastasis. Interventions: After fluid resuscitation, blood transfusion, application of proton pump inhibitors, and Octreotide, the patient recovered gradually. Then, nasojejunal feeding tube was placed for enteral nutrition and tumor exclusion. Subsequently, the patient received 5 cycles of neoadjuvant S-1 plus oxaliplatin regimen, without signs of rebleeding, followed by radical distal gastrectomy. Outcomes: Pathological examination confirmed that the patient received pathological complete response. Lessons: This case suggests that neoadjuvant chemotherapy is feasible in selected hemorrhagic gastric cancer patients and tumor exclusion is helpful in reducing rebleeding risk.