Yamamoto Michihiro, Zaima Masazumi, Yamamoto Hidekazu, Harada Hideki, Kawamura Junichiro, Yamaguchi Tetsuya
Hepatogastroenterology. 2015 May;62(139):752-7.
BACKGROUND/AIMS: In cases of remnantgastric cancer (RGC) with previous lymphadenectomy, laparoscopic total gastrectomy (LTG) is still uncommon because of the technical difficulties associated with adhesions from previous gastric cancer surgery and variations in anastomotic reconstruction. Here we demonstrate our procedure of LTG for RGC following distal gastrectomy (DG) with radical lymphadenectomy and review its clinical results.
From October 2008 to June 2014, we carried out three consecutive LTGs for RGC with previous lymphadenectomy. All cases had a past history of primary gastric cancer that had required open or laparoscopic DG with D2 radical lymphadenectomy. The preoperative TNM statuses of RGC were all cT1N0M0.
All patients successfully underwent LTG without open conversion or intraoperative complications. The median operative duration was 360 min; the median blood loss was 45 mL. The median number of retrieved lymph nodes was 23. No complications occurred postoperatively, and the median length of postoperative hospitalization was 20 days. The pathological TNM statuses of the RGC were all T1N0M0. Resection margins were negative in all cases (R0).
Our novel procedure of LTG for RGC following DG with radical lymphadenectomy is technically acceptable, safe, and feasible.
背景/目的：在既往已行淋巴结清扫术的残胃癌（RGC）病例中，由于既往胃癌手术导致的粘连以及吻合口重建方式的差异所带来的技术难题，腹腔镜全胃切除术（LTG）仍不常见。在此，我们展示了我们对行远端胃切除术（DG）并根治性淋巴结清扫术后的RGC进行LTG的手术过程，并回顾其临床结果。
从2008年10月至2014年6月，我们连续对3例既往已行淋巴结清扫术的RGC患者实施了LTG。所有病例均有原发性胃癌病史，曾接受过开放或腹腔镜DG及D2根治性淋巴结清扫术。RGC的术前TNM分期均为cT1N0M0。
所有患者均成功接受了LTG，未中转开腹或出现术中并发症。中位手术时间为360分钟；中位失血量为45毫升。中位清扫淋巴结数目为23枚。术后未发生并发症，中位术后住院时间为20天。RGC的病理TNM分期均为T1N0M0。所有病例切缘均为阴性（R0）。
我们对行DG并根治性淋巴结清扫术后的RGC进行LTG的新手术方法在技术上是可行的、安全的。
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