A man in his 60s had undergone distal gastrectomy for early gastric cancer with perigastric lymph node metastases at an other hospital in April, 2007. Six months later, he developed para-aortic lymph node metastases and underwent para-aortic lymph node dissection in January, 2008 following systemic chemotherapy including, S-1 plus cisplatin. However, para-aortic lymph node metastases recurred with neck lymph node metastases, and he was treated with several different chemotherapeutic regimens,

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... cluding S-1 alone, CPT-11 plus cisplatin, and docetaxel. After all of these therapies failed in some courses, he underwent para-aortic lymph node dissection for abdominal para-aortic lymph node metastases four times, and he additionally underwent radiotherapy for para-aortic and neck lymph node metastases. Although he did not relapse for a year after the final surgery, he developed peritoneal metastases. He has survived for 5 years and 4 months since the gastrectomy and for 4 years and 10 months since the initial discovery of the para-aortic lymph node metastases. This case shows that repeated loco-regional treatment, such as surgical dissection and radiotherapy, could contribute to longer survival in patients with lymph node recurrence.