Distal gastric tube resection with vascular preservation for gastric tube cancer: A case report and review of literature

doi:10.4240/wjgs.v12.i9.397

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World Journal of Gastrointestinal Surgery

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Case Report

World J Gastrointest Surg. Sep 27, 2020; 12(9): 397-406
Published online Sep 27, 2020. doi: 10.4240/wjgs.v12.i9.397

Distal gastric tube resection with vascular preservation for gastric tube cancer: A case report and review of literature

Masahiro Yura, Kazuo Koyanagi, Kiyohiko Adachi, Asuka Hara, Keita Hayashi, Yuki Tajima, Yasushi Kaneko, Hiroto Fujisaki, Akira Hirata, Kiminori Takano, Kumiko Hongo, Kikuo Yo, Kimiyasu Yoneyama, Reiko Dehari, Motohito Nakagawa

Masahiro Yura, Kiyohiko Adachi, Asuka Hara, Keita Hayashi, Yuki Tajima, Yasushi Kaneko, Hiroto Fujisaki, Akira Hirata, Kiminori Takano, Kumiko Hongo, Kikuo Yo, Kimiyasu Yoneyama, Motohito Nakagawa, Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan

Kazuo Koyanagi, Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Japan

Reiko Dehari, Department of Surgical Pathology, Hiratsuka City Hospital, Kanagawa 2540065, Japan

Author contributions: Yura M and Koyanagi K performed the surgery and wrote the paper; Nakagawa M reviewed the manuscript; Dehari R contributed to pathological diagnosis; All other authors equally contributed to medical treatment; All authors were responsible for the revision of the manuscript and final approval for submission.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: None of the authors declare any conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Masahiro Yura, MD, Doctor, Surgeon, Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka-shi, Kanagawa 2540065, Japan. myura@ncc.go.jp

Received: June 15, 2020
Peer-review started: June 15, 2020
First decision: July 21, 2020
Revised: August 1, 2020
Accepted: August 31, 2020
Article in press: August 31, 2020
Published online: September 27, 2020
Processing time: 102 Days and 0.6 Hours

Abstract

BACKGROUND

Survival rates in patients with esophageal cancer undergoing esophagectomy have improved, but the prevalence of gastric tube cancer (GTC) has also increased. Total resection of the gastric tube with lymph node dissection is considered a radical treatment, but GTC surgery is more invasive and involves a higher risk of severe complications or death, particularly in elderly patients.

CASE SUMMARY

We report an elderly patient with early GTC that had invaded the duodenum who was successfully treated with resection of the distal gastric tube and Roux-en-Y (R-Y) reconstruction. The tumor was a type 0-IIc lesion with ulcer scars surrounding the pyloric ring. Endoscopic submucosal resection was not indicated because the primary lesion was submucosally invasive, was undifferentiated type, surrounded the pyloric ring, and had invaded the duodenum. Resection of distal gastric tube with R-Y reconstruction was safely performed, with preservation of the right gastroepiploic artery (RGEA) and right gastric artery (RGA).

CONCLUSION

Distal resection of the gastric tube with preservation of the RGEA and RGA is a good treatment option for elderly patients with cT1bN0 GTC in the lower part of the gastric tube.

Keywords: Gastric tube cancer; Distal resection; Preservation of right gastroepiploic artery and right gastric artery; Elderly patients; Duodenal invasion; Case report; Posterior mediastinal reconstruction

Core Tip: Surgical removal of the reconstructed gastric tube is invasive and carries a relatively high risk of postoperative morbidity and mortality, especially for elderly patients. We present the case of an 82-year-old man who underwent successful resection of distal gastric tube for early gastric tube cancer with duodenal invasion. The interesting features of this case include the advanced age of the patient, distal resection of a gastric tube reconstructed via the posterior mediastinal route, and preservation of the right gastroepiploic artery and right gastric artery. None of these features have been described in previous reports.