A 74-year-old man underwent distal gastrectomy for gastric cancer(CY1, fStage 
Ⅳ). About 18 months after surgery, abdominal CT scans revealed multiple lymph 
node metastases along the portal vein. Systemic chemotherapy was administered 
comprising a capecitabine/oxaliplatin(CAPOX)regimen. After 4 courses of 
chemotherapy, an adverse reaction of Grade 2 diarrhea and peripheral neuropathy 
occurred, although regression of the lymph node metastasis was confirmed. 
Ramucirumab was administered as the second-line regimen, but CT imaging revealed 
lymph node progression after several courses. Although irinotecan(CPT-11)was 
selected as the third-line chemotherapy, the lymph node progression remained 
uncontrolled. Nivolumab was selected as the fourth-line chemotherapy. After 23 
courses, nivolumab immunotherapy induced a partial response to the lymph node 
metastasis. Nivolumab immunotherapy continues to be administered until now, 5 
years after the operation. We experienced a case of lymph node metastasis from 
gastric cancer successfully treated with nivolumab chemotherapy.