What happened, in summary

A 73-year-old man had persistent high fevers despite treatment for a presumed infection. Imaging eventually found an upper abdominal mass, and gastroscopy showed an ulcerated lesion involving the gastric antrum and lower body. Initial biopsy suggested adenocarcinoma.

He underwent totally laparoscopic total gastrectomy with D2 lymph-node dissection. Final pathology showed an 8 cm gastric adenosquamous carcinoma containing both gland-forming adenocarcinoma and squamous-cell components. The tumor had reached the serosal layer, but none of 35 lymph nodes contained cancer and no lymphatic or vascular invasion was identified. His fever and inflammatory markers fell promptly after the operation.

After surgery, he received adjuvant radiotherapy and S-1 chemotherapy. Recovery was uncomplicated, and his nutritional status improved. At nearly 20 months of follow-up, CT imaging showed no recurrence and he remained in good health.