{
  "abstract": "Background\n\nThe treatment strategy for advanced gastric cancer is significantly changing with the development of immune checkpoint inhibitors. While the efficacy of immune checkpoint inhibitors has been demonstrated, immune-related adverse events can present a wide spectrum of symptoms, ranging from mild and non-specific to severe symptoms. In some cases, intensive care unit management is required. Despite the widespread application of immune checkpoint inhibitor therapy, perioperative immune-related adverse events remain under-reported and insufficiently discussed.Case presentation\n\nCase 1 is a 46-year-old Japanese female underwent laparoscopic proximal gastrectomy after S-1, oxaliplatin plus nivolumab therapy for unresectable locally advanced esophagogastric junction cancer and developed diabetic ketoacidosis and fulminant type 1 diabetes mellitus 37 days after surgery. Case 2 is a 78-year-old Japanese male underwent staging laparoscopy after S-1, oxaliplatin plus nivolumab therapy for unresectable advanced gastric cancer and developed fulminant type 1 diabetes mellitus and bullous pemphigoid 13 days after surgery. Case 3 is a 64-year-old Japanese male underwent distal gastrectomy with D2 lymph node dissection and para-aortic lymph node sampling after S-1, oxaliplatin plus nivolumab therapy for unresectable advanced gastric cancer and developed clinically suspected immune-related encephalitis 2 days after surgery. All three patients required intensive care management with temporary ventilatory support. Appropriate treatment was performed, and all patients are alive and undergoing postoperative treatment.Conclusion\n\nAs immune checkpoint inhibitors are increasingly incorporated into multidisciplinary treatment for gastric cancer, surgeons may encounter severe perioperative immune-related adverse events requiring intensive care management. Awareness of these presentations and prompt multidisciplinary management may help facilitate early recognition and appropriate treatment.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan. hhadatsu@ncc.go.jp.",
    "Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.",
    "Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan. yoshikawa-tak.um@yokohama-cu.ac.jp."
  ],
  "article_type": null,
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  "author_total": 10,
  "authors": [
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      "name": "Hiroshi Hadatsuki"
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      "name": "Maho Takuwa"
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        1
      ],
      "name": "YuKi Takenaka"
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    {
      "affs": [
        1
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      "name": "Yurina Fujisaki"
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    {
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      "name": "Rei Ogawa"
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    {
      "affs": [
        1
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      "name": "Takeyuki Wada"
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    {
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        1
      ],
      "name": "Tsutomu Hayashi"
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    {
      "affs": [
        1
      ],
      "name": "Yukinori Yamagata"
    },
    {
      "affs": [
        2
      ],
      "name": "Takaki Yoshikawa"
    },
    {
      "affs": [
        1
      ],
      "name": "Yasuyuki Seto"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b2vjgw45h8ybs.bib",
  "cited_by": 0,
  "doi": "10.1186/s13256-026-06242-1",
  "fulltext_url": "https://europepmc.org/articles/PMC13685139",
  "id": "b2vjgw45h8ybs",
  "issns": [
    "1752-1947"
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  "landing_url": "https://europepmc.org/article/MED/42902407",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
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  "native_subjects": [
    [
      "lcc",
      "R"
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      "openalex",
      "2730|Cancer Immunotherapy and Biomarkers"
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  "pdf_url": "https://europepmc.org/articles/PMC13685139?pdf=render",
  "pmcid": "PMC13685139",
  "pmid": "42902407",
  "published": "2026-09-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/b2vjgw45h8ybs.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:41Z",
      "native_id": "MED:42902407",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42902407"
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    {
      "first_seen": "2026-10-30T13:45:58Z",
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      "url": "https://doi.org/10.1186/s13256-026-06242-1"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Cancer Immunotherapy and Biomarkers",
      "subfield": "oncology"
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  ],
  "title": "Severe perioperative immune-related adverse events requiring intensive care in patients with gastric cancer: a case series.",
  "title_text": "Severe perioperative immune-related adverse events requiring intensive care in patients with gastric cancer: a case series.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:45:58Z",
  "url": "https://research.draconitic.com/paper/b2vjgw45h8ybs",
  "venue": "Journal of medical case reports",
  "versions": []
}