Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2023; 15(9): 2063-2073
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.2063
Laparoscopy-assisted gastrectomy for advanced gastric cancer patients with situs inversus totalis: Two case reports and review of literature
Hong-Bo Liu, Xiao-Peng Cai, Zhao Lu, Bin Xiong, Chun-Wei Peng
Hong-Bo Liu, Xiao-Peng Cai, Zhao Lu, Bin Xiong, Chun-Wei Peng, Department of Gastrointestinal Surgery, Hubei Key Laboratory of Tumor Biological Behaviors & Hubei Cancer Clinical Study Center, Wuhan Peritoneal Cancer Clinical Medical Center, Zhongnan Hospital of Wuhan University, Wuhan 430070, Hubei Province, China
Hong-Bo Liu, School of Nursing, Wuhan University, Wuhan 430070, Hubei Province, China
Author contributions: Liu HB and Peng CW contributed to manuscript writing and editing, and data collection; Cai XP and Lu Z contributed to data analysis; Xiong B and Peng CW contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81401515; Zhongnan Hospital of Wuhan University Science Technology and Innovation Seed Fund, No. znpy2018030; “351Talent Project (Luojia Young Scholars)” of Wuhan University.
Informed consent statement: Informed written consent was obtained from both patients for the publication of this case report.
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: Chun-Wei Peng, MD, PhD, Doctor, Department of Gastrointestinal Surgery, Hubei Key Laboratory of Tumor Biological Behaviors & Hubei Cancer Clinical Study Center, Wuhan Peritoneal Cancer Clinical Medical Center, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan 430070, Hubei Province, China. whupengcw@whu.edu.cn
Received: March 20, 2023
Peer-review started: March 20, 2023
First decision: June 17, 2023
Revised: July 1, 2023
Accepted: July 25, 2023
Article in press: July 25, 2023
Published online: September 27, 2023
Processing time: 186 Days and 0.5 Hours
Abstract
BACKGROUND

Situs inversus totalis (SIT) is a rare condition in which the positions of abdominal and thoracic organs present a “mirror image” of the normal ones in the median sagittal plane. Although minimally invasive surgery has evolved to achieve laparoscopic gastrectomy for gastric cancer (GC) patients with SIT, it is difficult to perform lymphadenectomy (LND) in such a transposed anatomical condition. Herein, we report the cases of two patients with SIT who successfully underwent laparoscopy-assisted gastrectomy (LAG) with D2 LND.

CASE SUMMARY

Case 1: A 65-year-old man was admitted for intermittent abdominal pain and distension, occasional belching, and acid reflux for 4 mo. He was diagnosed with GC (cT3N1-2M0) with SIT. Before surgery, he had undergone four cycles of neoadjuvant chemotherapy and immunotherapy. Then, the patient was evaluated as having a partial response, and laparoscopy-assisted distal gastrectomy with D2 LND and Billroth II reconstruction were performed. The operation was performed successfully within 240 min with an estimated blood loss of 50 mL and no severe complications. The patient was discharged on postoperative day (POD) 9. Case 2: A 55-year-old man was admitted for upper abdominal distension with pain and discomfort after eating for 3 mo. He was diagnosed with GC (cT3N1M0) with SIT. He had a history of hypertension for more than 10 years; however, his blood pressure was well-controlled via regular medication. We performed laparoscopy-assisted total gastrectomy with D2 LND and Roux-en-Y reconstruction. The operation was performed successfully within 168 min with an estimated blood loss of 50 mL and no severe complications. The patient was discharged on POD 10.

CONCLUSION

LAG with D2 LND could be considered an accessible, safe, and curative procedure for advanced GC patients with SIT.

Keywords: Situs inversus totalis; Laparoscopy-assisted gastrectomy; Advanced gastric cancer; Surgery modality; Lymphadenectomy; Case report

Core Tip: Laparoscopic surgery in situs inversus totalis (SIT) patients with gastric cancer (GC) is exceedingly rare and challenging. We report the cases of two advanced GC patients with SIT who successfully underwent laparoscopy-assisted gastrectomy with D2 lymphadenectomy. In this report, we share our experience and review the literature in the previous 11 years to summarize the general consensus on laparoscopic radical gastrectomy in patients with SIT.