위암의 수술 방법에 대해서는 논란의 여지가 있지만 아직까지 수술이 국소적인 진행성 위암의 근치적인 치료로 첫번째 방법이다. 하지만 위암을 진단 받은 환자들 중에서 약 30%만이 수술이 가능한 진행성 위암으로 진단을 받으며 그 중 약 40~60%만이 R0 절제술이 가능하다. 저자들은 위 주위 림프절과 복강림프절, 장막을 침범한 진행성 위암을 진단 받은 환자를 5주간의 동시 항암 화학-방사선 요법으로 치료하였고, 근치적인 목적으로 부분 위 절제술을 시행하였으며 조직병리 검사에서 완전히 괴사된 종양 조직을 관찰할 수 있었고, 수술 후 6차례의 추가적인 전신 항암화학요법을 시행하였으며 추적 복부전산화단층촬영에서 재발을 시사하는 소견을 보이지 않았다.

Although the required extent of lymph node dissection remains controversial, surgery is the cornerstone of the treatment of advanced gastric cancer. However, only approximately 30% of patients are diagnosed as operable, and an R0 resection will be achieved in only 40~60% of these. Since R0 resection and the treatment response of the primary cancer or resected specimen are significant prognostic factors in locally advanced gastric cancer, various preoperative treatment modalities have been attempted to induce downstaging and improve complete nodal resection. Several recent studies revealed that preoperative chemoradiation therapy can prolong patient survival by improving the R0 resection rate and treatment response. Here, we present an advanced gastric cancer patient with serosal penetration involving multiple perigastric and celiac lymph nodes who underwent radical surgery and entered complete remission after S1 and cisplatin-based concurrent chemoradiation therapy. Pathology revealed total necrosis of the tumor cells, and fibrous nodules in 2 out of 47 resected lymph nodes indicated dead cancer cells due to chemoradiation therapy. Subsequently, the patient received an additional six rounds of postoperative adjuvant chemotherapy with uracil/tegafur (UFT) and cisplatin. Follow-up imaging showed no evidence of tumor recurrence. (Korean J Med 76:343-347, 2009)