α-Fetoprotein-producing gastric cancer (AFP-GC) accounts for 1.6-4.3% of all gastric cancers and has biological aggressiveness, with frequent hepatic and lymph node metastases, resulting in a poor prognosis[
1‐
4]. The mechanism of the aggressive behavior of AFP-GC has been under investigation. Recent molecular biological and genetic studies of AFP-CG have suggested that its malignancy is related to high vessel density[
5], high expression of vascular epidermal growth factor (VEGF)[
5], high expression of VEGF-C[
6], frequent
p53 abnormalities[
3], high expression of c-
Met[
7], absence of AT motif binding factor 1[
8], frequent loss of heterozygosity[
9], and high fractional allelic loss in the tumor cells[
9]. AFP-GC is pathologically divided into 2 types, hepatoid adenocarcinoma and nonhepatoid adenocarcinoma, including poorly/moderately/well-differentiated adenocarcinoma of common type gastric cancer and enteroblastic adenocarcinoma[
10,
11]. Most tumors have both hepatoid and non-hepatoid components[
10]. Although a portal vein tumor thrombus (PVTT) occurs frequently in hepatocellular carcinoma[
12], it is rarely observed in gastric cancer[
13]. The data of the 18
th follow-up survey of primary liver cancer by The Liver Cancer Study Group of Japan demonstrated that 26.1% of 5,368 patients with Hepatocellular carcinoma (HCC) had microscopic PVTT[
14]. The annual report of the pathological autopsy cases in Japan showed that PVTT occurred in 1.2% of patients with gastric cancer[
15]. It should be noted here that PVTT in liver cancer includes tumor thrombus in the intrahepatic portal vein, whereas PVTT in gastric cancer usually means thrombus limited to the main trunk or the first branch of the portal vein. Eom et al. reported that the median survival of patients with gastric cancer with PVTT was very short, at 5.4 months[
16]. There have been few reports of salvage surgery after chemotherapy for AFP-GC in the English literature[
17]. A case of AFP-GC with PVTT who has survived for 48 months without recurrence after salvage gastrectomy following chemotherapy with S-1 plus cisplatin is reported.