Laparoscopic radical gastrectomy for gastric cancer following liver transplantation: a report of a rare and complex case and a multidisciplinary management strategy.

De novo gastric cancer after liver transplantation is clinically rare, and radical resection remains the only potentially curative treatment. However, post-transplant anatomical distortion and extensive intra-abdominal adhesions increase surgical complexity, while long-term immunosuppression elevates the risks of perioperative infection and organ dysfunction. Furthermore, chemotherapy and immune checkpoint inhibitors may precipitate graft rejection. We report a 68-year-old man who underwent liver transplantation 18 years earlier for HBV-related hepatocellular carcinoma (T1aN0M0), meeting the Milan criteria. Preoperatively, serum HBV DNA was 2.3 × 103 IU/mL. He received entecavir and basiliximab induction, followed by early triple immunosuppression and long-term tacrolimus maintenance. During follow-up, HBV DNA remained undetectable, liver function was stable, and no transplant-related complications occurred. Eighteen years after transplantation, he presented with upper abdominal pain. Imaging and endoscopy demonstrated cT4N1M0 gastric adenocarcinoma of the antrum with hepatic parenchymal invasion. Following multidisciplinary discussion, laparoscopic D2 radical gastrectomy with Roux-en-Y reconstruction, partial hepatectomy, and ultra-tension-reducing abdominal wall closure were performed. The postoperative course was uneventful. This case suggests that multidisciplinary, standardized perioperative management can enable safe radical laparoscopic gastrectomy in selected liver transplant recipients.