Successful robot-assisted minimally invasive surgery for scirrhous gastric conduit cancer after esophagectomy: A case report.

Patients with reconstructed gastric conduit cancer following esophageal cancer surgery can be treated through gastric conduit resection and regional lymph node dissection for pathological R0 resection. However, these procedures are difficult owing to the adhesions and scars around the gastric conduit and anatomical irregularities. To the best of our knowledge, robotic resection for scirrhous gastric conduit cancer occurring along almost the entire reconstructed gastric conduit has not been reported in the literature to date. The present study report the case of a 69-year-old man who underwent radical robot-assisted surgery for advanced gastric conduit cancer along most of the gastric conduit with regional lymph node metastases. The patient had previously undergone robot-assisted thoracoscopic esophagectomy and posterior mediastinal gastric conduit reconstruction for thoracic esophageal cancer at another hospital. Subsequently, 5 years later, the patient underwent esophagogastroduodenoscopy for a passage disorder, during which an elevated lesion with severe stenosis was found at the esophagogastric anastomosis, along with mucosal irregularity along the reconstructed gastric conduit that was then pathologically diagnosed as poorly differentiated adenocarcinoma. Thereafter, the patient was referred to Kanazawa Medical University Hospital (Kahoku, Japan) where he underwent robotic intrathoracic surgery. Forceps manipulations under a three-dimensional magnified view were conducted to dissect the adhesions around the lung, chest wall, tracheal membranous portion and reconstructed gastric conduit. Curative total remnant gastrectomy with lymph node dissection and digestive-tract reconstruction using a pedicled jejunum were conducted without severe intraoperative injuries. Pathological analysis of the resected specimen indicated scirrhous gastric conduit cancer originating along the gastric conduit with marked full-thickness fibrosis and clusters of adenocarcinoma cells. No obvious cancer remnants were found on the dissected surface of the subserous layer of the gastric conduit. After postoperative adjuvant chemotherapy with oral tegafur/gimeracil/oteracil and intravenous docetaxel for 4 months, the patient was alive without recurrence at 9 months postoperatively.