Tanabe Kazuaki, Saeki Yoshihiko, Ohta Hiroshi, Ohdan Hideki
Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Department of Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Int J Surg Case Rep. 2022 May;94:107040. doi: 10.1016/j.ijscr.2022.107040. Epub 2022 Apr 14.
Adenocarcinoma of the esophagogastric junction (AEJ) has been on the rise in recent years, but the technical aspects of reconstruction and reflux prevention are unsolved problems. This case report aimed to illustrate the usefulness of preoperative chemotherapy for tumor shrinkage and the advantage of robotic surgery for stable reconstruction with reflux prevention.
A 69-year-old male patient was diagnosed with AEJ cT3N0M0 cStage IIB. Three courses of doublet chemotherapy with 80 mg/m/day of S-1 on days 1-14 and 100 mg/m of oxaliplatin on day 1 were administered every 3 weeks before surgery. After chemotherapy, the tumor shrunk, and the proximal margin changed from 1.5 cm above the esophagogastric junction (EGJ) to be the gastric side of the EGJ. A radical robotic proximal gastrectomy with D2 lymphadenectomy was performed. Since sufficient length of the esophagus was secured in the hiatus due to tumor shrinkage, reconstruction was performed by the side-overlap esophagogastrostomy (mSOFY) method. The postoperative course was uneventful with no reflux symptoms two months after surgery, even without medication.
Preoperative chemotherapy is expected to improve the rates of complete resection and survival. In the present case, preoperative treatment with SOX resulted in tumor shrinkage, which enabled reconstruction using the mSOFY method. Robotic surgery may be useful for such complex reconstruction procedures.
To our knowledge, this is the first report of robotic reconstruction using the mSOFY method after proximal gastrectomy for AEG tumors. This work was reported in line with the SCARE 2020 criteria.
近年来，食管胃交界腺癌（AEJ）的发病率呈上升趋势，但重建技术和反流预防方面的问题仍未解决。本病例报告旨在说明术前化疗对肿瘤缩小的作用以及机器人手术在稳定重建并预防反流方面的优势。
一名69岁男性患者被诊断为AEJ cT3N0M0 cIIB期。术前每3周进行3个疗程的双药化疗，第1 - 14天给予S-1 80mg/m²/天，第1天给予奥沙利铂100mg/m²。化疗后，肿瘤缩小，近端切缘从食管胃交界（EGJ）上方1.5cm变为EGJ的胃侧。行机器人辅助根治性近端胃切除术及D2淋巴结清扫术。由于肿瘤缩小，食管在裂孔处获得了足够长度，采用侧侧吻合食管胃吻合术（mSOFY）进行重建。术后恢复顺利，术后两个月无反流症状，无需药物治疗。
术前化疗有望提高完整切除率和生存率。在本病例中，术前SOX治疗导致肿瘤缩小，从而能够采用mSOFY方法进行重建。机器人手术可能有助于此类复杂的重建手术。
据我们所知，这是首例近端胃切除术后采用mSOFY方法对AEG肿瘤进行机器人重建的报告。本研究按照SCARE 2020标准报告。
