ArticleSurgical case reports2026
Conversion Surgery for Advanced Gastric Cancer with Para-Aortic Lymph Node Metastases Following Treatment with Capecitabine, Oxaliplatin, and Pembrolizumab: A Case Report.
Article in Surgical case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionImmune checkpoint inhibitors (ICIs) have recently emerged as an important treatment option for various cancers. In 2024, pembrolizumab was approved as a first-line treatment for unresectable or recurrent gastric cancer. Conversion surgery following ICI-based chemotherapy has been reported; however, cases involving pembrolizumab-based first-line therapy remain rare. Here, we report a case of conversion surgery after treatment with capecitabine plus oxaliplatin (CAPOX), combined with pembrolizumab for unresectable advanced gastric cancer. CASE PRESENTATION: An 82-year-old man presented with anorexia and was referred to our department for surgical evaluation. Upper gastrointestinal endoscopy revealed circumferential type 3 gastric cancer extending from the lower gastric body to the antrum with pyloric stenosis. Contrast-enhanced CT showed para-aortic lymph node metastases, resulting in a diagnosis of stage IVB gastric cancer (cT4aN2M1, 15th edition of the Japanese Classification of Gastric Carcinoma [JGCA]). First, we performed a laparoscopic gastrojejunal bypass to treat anorexia and oral intake difficulties due to pyloric stenosis. The patient then received 5 cycles of CAPOX plus pembrolizumab. Subsequent upper gastrointestinal endoscopy revealed significant scarring with residual cancer cells, and contrast-enhanced CT showed significant shrinkage of the primary tumor lesion and para-aortic lymph nodes. Because R0 resection was achievable, we performed conversion surgery involving open distal gastrectomy with D2 and para-aortic lymphadenectomy. Postoperative pathological findings revealed a small number of residual cancer cells in the submucosa, with no viable cancer cells detected in the para-aortic lymph nodes (ypT1bN0M0, ypStage IA). The pathological response grade was 2b according to the 15th edition of the JGCA. At 6 months postoperatively, the patient remains alive and recurrence-free.
conclusionsConversion surgery after CAPOX plus pembrolizumab chemotherapy is a potential therapeutic strategy for unresectable advanced gastric cancer.
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