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Peer-reviewedCC BY-NC-NDJournal of medical case reports

Severe perioperative immune-related adverse events requiring intensive care in patients with gastric cancer: a case series.

  • Hiroshi Hadatsuki1
  • Maho Takuwa2
  • YuKi Takenaka2
  • Yurina Fujisaki2
  • Rei Ogawa2
  • Takeyuki Wada2
  • Tsutomu Hayashi2
  • Yukinori Yamagata2
  • Takaki Yoshikawa3
  • Yasuyuki Seto2
  1. 1Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan. [email protected].
  2. 2Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
  3. 3Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan. [email protected].
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Abstract

Background

The 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

Case 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

As 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.

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Cite

BibTeXRIS
BibTeX
@article{hadatsuki2026severe,
  title = {{Severe perioperative immune-related adverse events requiring intensive care in patients with gastric cancer: a case series.}},
  author = {Hiroshi Hadatsuki and Maho Takuwa and YuKi Takenaka and Yurina Fujisaki and Rei Ogawa and Takeyuki Wada and Tsutomu Hayashi and Yukinori Yamagata and Takaki Yoshikawa and Yasuyuki Seto},
  journal = {Journal of medical case reports},
  year = {2026},
  month = sep,
  doi = {10.1186/s13256-026-06242-1},
  url = {https://europepmc.org/article/MED/42902407},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Severe perioperative immune-related adverse events requiring intensive care in patients with gastric cancer: a case series.
AU  - Hiroshi Hadatsuki
AU  - Maho Takuwa
AU  - YuKi Takenaka
AU  - Yurina Fujisaki
AU  - Rei Ogawa
AU  - Takeyuki Wada
AU  - Tsutomu Hayashi
AU  - Yukinori Yamagata
AU  - Takaki Yoshikawa
AU  - Yasuyuki Seto
PY  - 2026
DA  - 2026/09/01
JO  - Journal of medical case reports
DO  - 10.1186/s13256-026-06242-1
UR  - https://europepmc.org/article/MED/42902407
AB  - Background  The 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  Case 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  As 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.
SN  - 1752-1947
ER  -