Locally Advanced Synchronous Hemorrhagic Gastric Cancer—From the First Symptom to Therapy—Case Report

ABSTRACT Gastric cancer is one of the most common malignancies worldwide, and its incidence shows global variability, with the highest rates reported in Eastern Asia, Eastern Europe, and South America due to the aging population and growth of high‐risk groups. It is most often recognized in advanced stages due to the few symptoms and the low rate of regular screening. We present a case of a 62‐year‐old male patient treated in our department for synchronous hemorrhagic gastric cancer (T4b), with preoperative chemotherapy. A total gastrectomy, cephalic pancreaticoduodenotomy, and transverse colon resection were performed due to invasion of the transverse colon and the head of the pancreas. The treatment of advanced gastric cancer is multidisciplinary, including preoperative chemotherapy, surgical treatment, and adjuvant oncotherapy. To achieve an R0 resection, in some selected cases, it is necessary to perform extended resections. These extended resections increase the rate of early postoperative complications, but they have a positive impact on long‐term survival. Performing a cephalic pancreaticoduodenotomy simultaneously with gastric resection in advanced gastric cancers to achieve an R0 resection remains controversial, as the benefits of radical intervention are sometimes outweighed by its morbidity, but it can have a positive impact on long‐term survival.