Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1247
Peer-review started: February 17, 2023
First decision: February 28, 2023
Revised: March 3, 2023
Accepted: April 17, 2023
Article in press: April 17, 2023
Published online: June 27, 2023
Processing time: 118 Days and 10.3 Hours
Chemotherapy followed by gastrojejunostomy remains the main treatment for unresectable gastric cancer (GC) in the middle- or lower-third regions with gastric outlet obstruction (GOO). Radical surgery is performed as part of a multimodal treatment strategy for selected patients who respond well to chemotherapy. This study describes a case of successful radical resection with completely laparoscopic subtotal gastrectomy after a modified stomach-partitioning gastrojejunostomy (SPGJ) for obstruction relief, in a patient with GOO.
During the initial esophagogastroduodenoscopy, an advanced growth was detected in the lower part of the stomach, which caused an obstruction in the pyloric ring. Following this, a computed tomography (CT) scan revealed the presence of lymph node metastases and tumor invasion in the duodenum, but no evidence of distant metastasis was found. Consequently, we performed a modified SPGJ, a complete laparoscopic SPGJ combined with No. 4sb lymph node dissection, for obstruction relief. Seven courses of adjuvant capecitabine plus oxaliplatin combined with Toripalimab (programmed death ligand-1 inhibitor) were administered thereafter. A preoperative CT showed partial response; therefore, completely laparoscopic radical subtotal gastrectomy with D2 lympha
Laparoscopic SPGJ combined with No. 4sb lymph node dissection was an effective surgical technique for initially unresectable GC with GOO.
Core Tip: Radical resection, which may improve long-term survival, is often challenging in unresectable gastric cancer (GC) with gastric outlet obstruction (GOO) due to the management of complete gastrointestinal anastomoses and abdominal adhesions caused by gastrojejunostomy. We present a successful case of radical resection after laparoscopic stomach-partitioning gastrojejunostomy (SPGJ) combined with No. 4sb lymph node dissection, followed by conversion therapy; pathological complete remission was achieved. This case suggests that laparoscopic SPGJ combined with No. 4sb lymph node dissection is an option for initially unresectable GC with GOO.