Kimura Kotaro, Ebihara Yuma, Tanaka Kimitaka, Nakanishi Yoshitsugu, Asano Toshimichi, Noji Takehiro, Kurashima Yo, Murakami Soichi, Nakamura Toru, Tsuchikawa Takahiro, Okamura Keisuke, Shichinohe Toshiaki, Kanno-Okada Hiromi, Hirano Satoshi
Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo, 0608638, Hokkaido, Japan.
Department of Surgical Pathology, Hokkaido University Hospital, North 15 West 7, Kita-ku, Sapporo, 0608638, Hokkaido, Japan.
Int J Surg Case Rep. 2020;75:446-450. doi: 10.1016/j.ijscr.2020.09.147. Epub 2020 Sep 24.
Epstein-Barr virus-associated gastric cancer (EBVaGC) sometimes appears as multiple gastric cancer lesions. Here, we report a case of robot-assisted laparoscopic total gastrectomy (RTG) for a relatively rare disease with four synchronized lesions in EBVaGC and discuss the usefulness of robotic gastrectomy.
A 60-year-old woman was diagnosed with multiple gastric cancer because she had five lesions in the stomach and biopsy showed the presence of adenocarcinoma in four of the five lesions. We performed robot-assisted laparoscopic total gastrectomy on the patient. The histopathological diagnosis was multiple gastric cancer T1bN0M0 pStage IA. The four lesions were positive for the Epstein-Barr virus encoding region in in-situ hybridization and were considered to be EBVaGC. The patient had no sign of recurrence without postoperative therapy for 24 months.
EBVaGC was found in about 10% of all gastric cancer cases worldwide. EBVaGC sometimes appears as multiple gastric cancer, suggesting that EBV infection is closely related to the early stages of tumor formation. Total gastrectomy may be necessary for multiple gastric cancer such as EBVaGC, and robotic surgery is useful in total gastrectomy in terms of high-resolution three-dimensional images and using forceps with multi-joint functions.
We performed RTG on a patient with four synchronous lesions of EBVaGC, which is relatively rare. Robot-assisted laparoscopic total gastrectomy is known to be a safe procedure, and we effectively performed total gastrectomy for multiple EBVaGC.
爱泼斯坦-巴尔病毒相关胃癌（EBVaGC）有时表现为多发性胃癌病灶。在此，我们报告一例机器人辅助腹腔镜全胃切除术（RTG）治疗EBVaGC中一种相对罕见的具有四个同步病灶的疾病的病例，并讨论机器人胃切除术的实用性。
一名60岁女性被诊断为多发性胃癌，因为她胃内有五个病灶，活检显示五个病灶中的四个存在腺癌。我们对该患者进行了机器人辅助腹腔镜全胃切除术。组织病理学诊断为多发性胃癌T1bN0M0 pStage IA。四个病灶原位杂交检测爱泼斯坦-巴尔病毒编码区呈阳性，被认为是EBVaGC。患者术后未接受治疗，24个月无复发迹象。
在全球所有胃癌病例中，约10%发现有EBVaGC。EBVaGC有时表现为多发性胃癌，提示EBV感染与肿瘤形成的早期阶段密切相关。对于EBVaGC等多发性胃癌，可能需要进行全胃切除术，而机器人手术在全胃切除术中因具有高分辨率三维图像和使用具有多关节功能的钳子而很有用。
我们对一名患有四个同步病灶的EBVaGC患者进行了RTG，这相对罕见。机器人辅助腹腔镜全胃切除术是一种安全的手术，我们有效地对多发性EBVaGC进行了全胃切除术。
