Yamana Ippei, Fujikawa Takahisa, Kawamura Yuichiro, Hasegawa Suguru
Surgery, Kokura Memorial Hospital, Kitakyushu, JPN.
Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, JPN.
Cureus. 2024 Aug 21;16(8):e67446. doi: 10.7759/cureus.67446. eCollection 2024 Aug.
The right gastroepiploic artery (RGEA) is frequently used in coronary artery bypass grafting (CABG) for right coronary artery bypass requiring long-term patency. We experienced a case of upper-third advanced gastric cancer after CABG using RGEA. The absence of enlarged lymph nodes (LNs) or distant metastasis was confirmed through computed tomography (CT), and the RGEA graft remained patent according to coronary CT angiography. Based on these findings, the patient underwent robotic total gastrectomy while preserving the RGEA graft without infra-pyloric LN dissection. We suggested that caution should be exercised to avoid injury to the graft during gastrectomy, and robotic surgery could contribute to safely preserving the RGEA. We should consider the decision to dissect the infra-pyloric LN for the patient's safety and curability.
胃网膜右动脉（RGEA）常用于冠状动脉旁路移植术（CABG）中，以进行需要长期通畅的右冠状动脉旁路移植。我们遇到了一例在使用RGEA进行CABG术后发生胃上部进展期癌的病例。通过计算机断层扫描（CT）确认无肿大淋巴结（LNs）或远处转移，并且根据冠状动脉CT血管造影，RGEA移植物保持通畅。基于这些发现，患者接受了机器人辅助全胃切除术，保留了RGEA移植物，未进行幽门下淋巴结清扫。我们建议在胃切除术中应谨慎操作以避免损伤移植物，并且机器人手术有助于安全地保留RGEA。为了患者的安全和治愈率，我们应考虑是否进行幽门下淋巴结清扫的决策。
