[A Case of Unresectable Gastric Cancer Who Underwent Conversion Surgery after SP Therapy and Achieved Long-Term Survival].

The case was a man in his 60s. With a complaint of loss of appetite, a peripheral type 3 lesion was found from the lower body of the stomach to the vestibule, and a biopsy revealed poorly differentiated adenocarcinoma. CT examination revealed that the tumor had invaded the left lobe of the liver and the transverse colon, and that the para-aortic lymph nodes were swollen and multiple nodules of the gastrocolonic mesentery were found. After 6 courses of S-1 plus cisplatin(SP)therapy were performed, the tumor shrank and lymph node swelling and nodule disappearance were observed. Laparotomy and pyloric gastrectomy, partial liver resection, D2 dissection, and Roux-en-Y reconstruction were performed. As a result of histopathological examination, R0 was resected. After the operation, S-1 was taken orally for 1 year, and no recurrence or metastasis has been observed 6 and a half years after the operation. This time, we report a valuable case in which SP therapy was successful for unresectable gastric cancer and long-term survival was obtained by conversion surgery.

Presentation of unruptured right gastric aneurysm due to segmental arterial mediolysis resected laparoscopically: A case report.

INTRODUCTION: Timely diagnosis and treatment of intra-abdominal arterial aneurysms before rupture are highly recommended. We successfully prevented rupture through arterial aneurysm excision, highlighting the importance of the lack of reports on resection before rupture. CASE PRESENTATION: A 60-year-old male with previous history of ureteral stones presented complaining primarily of left-sided abdominal pain. Computed tomography (CT) revealed a left ureteral stone and incidentally identified a submucosal gastric tumor and right gastric artery aneurysm, leading to referral to our department. Blood tests showed no abnormalities. CT revealed a 23-mm submucosal tumor protruding outward from the middle gastric body wall. A 13-mm aneurysm was observed in the right gastric artery, and no other aneurysms were detected, including intracranially. Upper gastrointestinal endoscopy revealed a smooth elevation covered by normal mucosa in the middle gastric body. Endoscopic ultrasound-fine needle aspiration resulted in a diagnosis of gastrointestinal stromal tumor (GIST) and surgery. We performed simultaneous surgery involving laparoscopic local resection of the gastric GIST and identification and excision of the right gastric artery aneurysm due to its enlargement (7 mm on CT conducted six years ago). The patient's postoperative course was uneventful, and he was discharged on postoperative day 6. Pathological examination confirmed a diagnosis of segmental arterial mediolysis. DISCUSSION: Intra-abdominal arterial aneurysms affect approximately 1 % of the population. Splenic artery aneurysms are the most common at 58.7 %, whereas the gastric artery and gastroepiploic artery account for only 4.7 %. CONCLUSION: Right gastric artery aneurysms are exceedingly rare, with no reported cases of successful resection before rupture.