Dapri Giovanni, Gomez Maria Galdon, Cadière Guy-Bernard, Yang Han-Kwang
Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Laboratory of Anatomy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium.
Ann Surg Oncol. 2017 Jun;24(6):1658-1659. doi: 10.1245/s10434-017-5767-9. Epub 2017 Jan 24.
Minimally invasive surgery (MIS) is proved to be feasible and safe oncologically. In the past decade, a new philosophy of MIS, reducing abdominal trauma and improving the cosmetic results, has been popularized. The authors report a three trocars laparoscopic total gastrectomy + D2 lymphadenectomy for lesser curvature gastric adenocarcinoma.
A 52-year-old woman presenting a nondifferentiated gastric adenocarcinoma at the incisura angularis was admitted at consultation. Preoperative workup showed a T3N+M0 tumor. After neoadjuvant chemotherapy, laparoscopy was scheduled. Three trocars (5, 12, 5 mm) were placed in the abdomen. The operative field's exposure was improved by temporary percutaneous sutures. En bloc total gastrectomy and omentectomy was performed with a D2 lymphadenectomy, including the nodes of the stations 1, 2, 3, 4, 5, 6, 7, 8a, 8p, 9, 10, 11p, 11d, and 12a. Completely manual end-to-side esophago-jejunal anastomosis (Fig. 1a, b) and linear mechanical side-to-side jejuno-jejunal anastomosis were realized with the closure of both mesenteric and mesocolic defects. The specimen was retrieved through a suprapubic access.
Operative time was 4 hours and 45 minutes (anastomosis: 30), and perioperative bleeding was 100 cc. Pathologic report confirmed nondifferentiated adenocarcinoma, mucinous, G3, infiltrating entirely the gastric wall, with 63 (4 positive) nodes removed; 7 edition UICC stage: pT4aN2aM0; keratine AE1/AE3 negative, HER2/neu, and HER2/CEP17 nonamplified. During postoperative follow-up, no recurrence was detected after 2 years.
Reduced port laparoscopic surgery provides the same quality of oncologic surgery as conventional multitrocar laparoscopy with added superior cosmesis and reduced abdominal trauma.
微创外科手术（MIS）在肿瘤学方面已被证明是可行且安全的。在过去十年中，一种减少腹部创伤并改善美容效果的MIS新理念已得到推广。作者报告了一例采用三孔腹腔镜全胃切除术 + D2淋巴结清扫术治疗小弯侧胃腺癌的病例。
一名52岁女性因角切迹处未分化胃腺癌前来咨询并入院。术前检查显示为T3N + M0肿瘤。新辅助化疗后，安排进行腹腔镜手术。在腹部置入三个套管针（5、12、5毫米）。通过临时经皮缝合改善手术视野暴露。进行整块全胃切除术和网膜切除术，并进行D2淋巴结清扫，包括第1、2、3、4、5、6、7、8a、8p、9、10、11p、11d和12a组淋巴结。通过完全手工端端食管空肠吻合术（图1a、b）和线性机械侧侧空肠空肠吻合术实现了肠系膜和结肠系膜缺损的闭合。标本通过耻骨上切口取出。
手术时间为4小时45分钟（吻合时间：30分钟），围手术期出血量为100毫升。病理报告证实为未分化腺癌，黏液性，G3级，完全浸润胃壁，切除63个（4个阳性）淋巴结；第7版国际抗癌联盟（UICC）分期：pT4aN2aM0；细胞角蛋白AE1/AE3阴性，HER2/neu和HER2/CEP17未扩增。术后随访2年未发现复发。
减少切口的腹腔镜手术与传统多孔腹腔镜手术具有相同的肿瘤手术质量，且美容效果更佳，腹部创伤更小。
