What happened, in summary

A 55-year-old man was admitted in October 2016 after 6 months of upper-abdominal pain and a 15-kg weight loss. Endoscopy showed an infiltrative upper-stomach lesion resembling linitis plastica, and biopsy revealed signet-ring cell adenocarcinoma. CT and staging laparoscopy confirmed diffuse peritoneal metastases, making this Stage IV gastric cancer.

Before arriving at the reporting center, he had already received 8 cycles of FLOT chemotherapy. He then underwent laparoscopic HIPEC and received 2 cycles of combined systemic and intraperitoneal chemotherapy using the BISIC approach. Repeat laparoscopy showed a reduction in peritoneal disease.

He proceeded to total gastrectomy with D2 lymph-node dissection and resection of suspicious subdiaphragmatic and pelvic peritoneal areas, followed by HIPEC. Pathology showed residual mixed-type gastric adenocarcinoma and 17 involved lymph nodes among 22 removed, but no viable cancer in the resected peritoneal areas. After recovery, he completed 6 cycles of FOLFOX chemotherapy. At follow-up, he had no signs of recurrence.