Robotic D2 total gastrectomy with en-mass removal of the spleen and body and tail of the pancreas for locally advanced gastric cancer.

BACKGROUND

Safety and efficacy of robotic surgery in advanced gastric cancers (AGC) have not been proven by randomized control trials (Ojima et al., 2018) [1], and therefore, standard procedure for AGC is still open surgery. Robotic surgery, however, plays an essential role in ergonomics and offers advantages, such as motion scaling, tremor filtering, seven degrees of wrist-like motion, and three-dimensional vision. Here, we initially report successful robotic gastric cancer surgery on a 49-year-old male with proximal gastric cancer adherent to tail of pancreas and mesentery of the colon.

METHODS

The patient underwent a diagnostic laparoscopy 10 days before surgery, confirming negative peritoneal dissemination and washing cytology. The patient was placed in a supine position and we inserted five ports. We performed robotic D2 total gastrectomy with en-mass removal of the spleen and body and tail of the pancreas using the da Vinci Xi Surgical System (Intuitive, Sunnyvale, CA) (Japanese Gastric Cancer Association, 2017) [2]. After gastrectomy, to evaluate the blood supply of transverse colon, we employed Indocyanine Green fluorescence using the da Vinci Firefly system and performed a partial resection of the transverse colon and a colostomy. In order to avoid anastomotic leakage of colocolostomy due to pancreatic fistula, we chose to have end colostomy. Roux-en-Y esophago-jejunostomy and jejuno-jejunostomy reconstruction were performed robotically (Ojima et al., 2019) [3]. After the operation, a nasal feeding tube was inserted.

RESULTS

The operation took 472 min with no intraoperative complications and blood loss of 105 ml. Final pathological examination showed poorly-differentiated adenocarcinoma (T4BN1M0, TNM stage IIIC). The patient was discharged uneventfully on postoperative day 25. He is receiving adjuvant chemotherapy. At six months, there was no evidence of complications or recurrence.

CONCLUSIONS

Robotic D2 total gastrectomy with en-mass distal pancreatectomy and splenectomy are feasible and safe in advanced gastric cancer, however, its oncological value has yet to be determined.