Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Japan.
Asian J Endosc Surg. 2022 Jul;15(3):665-669. doi: 10.1111/ases.13047. Epub 2022 Mar 6.
Minimally invasive completion gastrectomy is technically demanding and comprises a variety of procedures depending on the previous operation. We present herein a case of robot-assisted completion gastrectomy preserving the interposed jejunum in remnant gastric cancer following a proximal gastrectomy reconstructed by jejunal interposition. A 76-year-old, male patient experienced newly developed stage cT1bN0M0 gastric cancer in the distal remnant stomach 5 years after his initial proximal gastrectomy. Endoscopic submucosal dissection was not feasible because of tumor depth and poor cancer cell differentiation. The robotic approach was chosen because of the early cancer stage, prior laparoscopic surgery, and the patient's advanced age. The interposed jejunum was successfully preserved, and a new overlap anastomosis was created between it and the retrocolic Roux-en-Y limb. Robot-assisted completion gastrectomy was safely performed even after a proximal gastrectomy with jejunal interposition.
微创完成性胃切除术技术要求较高，根据先前的手术情况，包含多种手术程序。我们在此报告一例残胃癌患者行机器人辅助完成性胃切除术的病例，该患者先前因近端胃切除术而行空肠间置术重建，此次手术保留了间置空肠。一位 76 岁男性患者在初次近端胃切除术后 5 年，于残胃远端新发生 cT1bN0M0 期胃癌。由于肿瘤深度和癌细胞分化不良，内镜黏膜下剥离术不可行。由于早期癌症阶段、先前的腹腔镜手术和患者高龄，选择了机器人手术方法。成功保留了间置空肠，并在其与结肠后 Roux-en-Y 袢之间创建了新的重叠吻合。即使在近端胃切除术后行空肠间置术，也可安全地进行机器人辅助完成性胃切除术。
