Shao XX, Xu Q, Wang BZ, Tian YT. Modified stomach-partitioning gastrojejunostomy for initially unresectable advanced gastric cancer with outlet obstruction: A case report. World J Gastrointest Surg 2023; 15(6): 1247-1255 [PMID: 37405097 DOI: 10.4240/wjgs.v15.i6.1247]
Corresponding Author of This Article
Yan-Tao Tian, PhD, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing 100021, China. tianyantao@cicams.ac.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1247-1255 Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1247
Modified stomach-partitioning gastrojejunostomy for initially unresectable advanced gastric cancer with outlet obstruction: A case report
Xin-Xin Shao, Quan Xu, Bing-Zhi Wang, Yan-Tao Tian
Xin-Xin Shao, Quan Xu, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Bing-Zhi Wang, Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Shao XX and Xu Q contributed equally to this study. Shao XX and Xu Q contributed to writing-original draft of the manuscript; Shao XX, Xu Q, Wang BZ, and Tian YY involved in the writing-review and editing of the manuscript; Shao XX, Xu Q, and Tian YY were major in the conceptualization; Tian YY contributed to the project administration and supervision; and all the authors have approved the final version of the manuscript.
Supported bythe National Natural Science Foundation of China, No. 82072734.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Tao Tian, PhD, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing 100021, China. tianyantao@cicams.ac.cn
Received: February 17, 2023 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
Abstract
BACKGROUND
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.
CASE SUMMARY
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 lymphadenectomy was performed after conversion therapy, and pathological complete remission was achieved.
CONCLUSION
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.
