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[A Case of Splenic-Hilum Lymph Node Recurrence after Spleen Preserving Total Gastrectomy for Gastric Cancer Following Neoadjuvant Chemotherapy].

A 69-year-old man was diagnosed with a large type 3, cT4bN2M0, cStage III c advanced gastric cancer located at the lesser curvature of the upper stomach. Neoadjuvant chemotherapy with S-1 plus CDDP was administered, and partial response was obtained after 2 courses. Subsequently, spleen preserving total gastrectomy with partial hepatectomy was performed. The final pathological diagnosis was UM, Less, yType 3, por1, ypT4b(SI liver), was ly2, v1, ypN2, M0, pStage III c, R0. Adjuvant chemotherapy with S-1 was administered; however, 5 months after the surgery, splenic-hilum lymph node recurrence was detected. Chemotherapy with CPT-11 plus CDDP was administered and a salvage operation was planned when the response to treatment was nonCR or nonPD. After 6 courses of chemotherapy, the treatment response was PR. Nine months after the first operation, spleno-pancreatic tail resection combined with partial hepatectomy was performed. The patient is currently disease-free without chemotherapy.