Lee Hyojin, Kim Yoo Min
Yonsei University College of Medicine, 50-1, Yonsei-Ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-Ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Int J Surg Case Rep. 2025 Aug;133:111558. doi: 10.1016/j.ijscr.2025.111558. Epub 2025 Jun 23.
Surgical methods to treat gastric cancer are quite straightforward. However, in rare cases of gastric cancer accompanied by a splenic mass that requires splenectomy, treatment options become much more complicated. Splenectomy can effectively treat splenic masses, but without adequate salvation of vessels, could increase the risk of ischemic necrosis if simultaneously performed with distal subtotal gastrectomy.
The patient is a 40-year-old male diagnosed with cancer at the stomach angle. Abdominal CT also confirmed a huge mass in the spleen, suspected to be sclerosing angiomatoid nodular transformation (SANT). 3-dimensional CT angiography and RUS™ software were used to visualize the patient's intraabdominal anatomy before and throughout surgery. The robotic approach was used to incorporate said technologies while intricately preserving the short gastric vessels. Indocyanine green was injected intravenously to confirm adequate perfusion to the remnant stomach.
Subtotal gastrectomy can be performed concurrently with splenectomy if the splenic and vascular anatomies allow for a safe splenectomy and preservation of the short gastric vessels. The feasibility of the operation should be confirmed by meticulous exploration of the patient's specific anatomy before and during surgery.
This report demonstrates a successful method to perform subtotal gastrectomy with splenectomy. Despite its complexity and time-consuming nature, this procedure can greatly benefit patients by allowing safe resections and maximal preservation of digestive functions, nutrition, and quality of life. As a result, we recommend that it be more readily considered when treating complex cases like this.
治疗胃癌的手术方法相当直接。然而，在罕见的伴有脾脏肿块且需要行脾切除术的胃癌病例中，治疗选择变得更加复杂。脾切除术可有效治疗脾脏肿块，但如果在远端胃次全切除术同时进行时，没有充分保留血管，则会增加缺血坏死的风险。
该患者为一名40岁男性，被诊断为胃角癌。腹部CT还证实脾脏有一个巨大肿块，怀疑为硬化性血管瘤样结节性转化（SANT）。使用三维CT血管造影和RUS™软件在手术前及手术全过程可视化患者的腹内解剖结构。采用机器人手术方法结合上述技术，同时精细地保留胃短血管。静脉注射吲哚菁绿以确认残胃有足够的灌注。
如果脾脏和血管解剖结构允许安全地进行脾切除术并保留胃短血管，则可在脾切除术的同时进行胃次全切除术。手术的可行性应在手术前和手术过程中通过仔细探查患者的具体解剖结构来确认。
本报告展示了一种成功进行胃次全切除术加脾切除术的方法。尽管该手术复杂且耗时，但通过实现安全切除并最大程度保留消化功能、营养和生活质量，可使患者大大受益。因此，我们建议在治疗此类复杂病例时更应优先考虑该方法。
