Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Asian J Endosc Surg. 2020 Jul;13(3):415-418. doi: 10.1111/ases.12741. Epub 2019 Jul 30.
Gastrojejunostomy has been performed as a palliative treatment for unresectable, advanced gastric cancer patients with gastric outlet obstruction (GOO). However, its role before neoadjuvant chemotherapy (NAC) has not been established. We present the case of a 72-year-old man with distal advanced gastric cancer with GOO. Computed tomography showed para-aortic lymph node (PAN) metastasis without other distal metastasis. We performed laparoscopic stomach-partitioning gastrojejunostomy (LSPGJ), which avoided new gastrojejunostomy reconstruction when performing distal gastrectomy after NAC. His oral intake improved after surgery and NAC was successfully administered on postoperative day 14, without surgical complications. After completion of NAC, the patient underwent radical distal gastrectomy with gastrojejunostomy reused as Billroth-II reconstruction. A histological examination revealed no residual cancer cells. LSPGJ, with partitioning on the expected resection line in distal gastrectomy after NAC, can be useful for treating advanced gastric cancer with GOO when NAC followed by curative gastrectomy is planned.
胃空肠吻合术已被用作无法切除的晚期胃癌伴胃出口梗阻 (GOO) 患者的姑息性治疗。然而，其在新辅助化疗 (NAC) 之前的作用尚未确定。我们报告了一例 72 岁男性，患有远端进展期胃癌伴 GOO。计算机断层扫描显示腹主动脉旁淋巴结 (PAN) 转移，无其他远处转移。我们进行了腹腔镜胃分隔胃空肠吻合术 (LSPGJ)，在 NAC 后行远端胃切除时避免了新的胃空肠吻合重建。他的术后口服摄入量改善，并且在术后第 14 天成功给予了 NAC，没有手术并发症。NAC 完成后，患者接受了根治性远端胃切除术，再次使用胃空肠吻合术进行 Billroth-II 重建。组织学检查显示无残留癌细胞。LSPGJ 在 NAC 后远端胃切除时在预计的切除线上进行分隔，对于计划接受 NAC 后根治性胃切除术的 GOO 晚期胃癌患者可能是有用的。
