A 71-year-old female, with nausea, was diagnosed with type 2 advanced gastric cancer in cardia. Examinations revealed cStage Ⅳ of cT4aN2M1 with paraaortic lymph node metastasis. S-1 plus oxaliplatin plus trastuzumab was performed for 6 courses. Because of adverse events, S-1 plus trastuzumab for 4 courses was followed. After that treatment, the primary tumor as well as metastatic lymph nodes were shown with marked reduction in size by CT scan, which enabled total gastrectomy with D2 plus paraaortic lymphadenectomy to be performed as a curative resection. The surgical specimen revealed pathological CR.
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