期刊论文详细信息
World Journal of Surgical Oncology
Robotic total gastrectomy with thrombectomy and portal vein reconstruction for gastric cancer and portal vein tumor thrombus
Nozomu Nakai1  Takahito Sugase1  Masayoshi Yasui1  Hirofumi Akita1  Hidenori Takahashi1  Masaaki Yamamoto1  Tomohira Takeoka1  Masayuki Ohue1  Takeshi Omori1  Shinichiro Hasegawa1  Naotsugu Haraguchi1  Hisashi Hara1  Hiroshi Wada1  Chu Matsuda1  Takashi Kanemura1  Hiroshi Miyata1  Kei Asukai1  Junichi Nishimura1  Naoki Shinno1  Yosuke Mukai1  Keijiro Sugimura1 
[1] Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567, Osaka, Japan;
关键词: Gastric cancer;    Portal vein tumor thrombus;    Robot;    Gastrectomy;    Thrombectomy;    Portal vein reconstruction;   
DOI  :  10.1186/s12957-022-02502-8
来源: Springer
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【 摘 要 】

BackgroundGastric cancer with portal vein tumor thrombus (PVTT) is poor prognosis, and the treatment remains challenging. Regarding surgery, there are only reports of highly invasive laparotomy. We report some techniques of the completely robotic total gastrectomy with thrombectomy and portal vein reconstruction for the patient with gastric cancer and PVTT for the first time.Case presentationA 79-year-old man was diagnosed with a 5-cm gastric cancer on the side of the lesser curvature from the middle of the gastric body to the cardia. Computed tomography revealed a massive PVTT extending from the left gastric vein to the portal trunk (28 x 16 mm). There were no other distant metastases. After 3 cycles of the chemotherapy, the PVTT shrank to 19 x 12 mm. After obtaining informed consent from the patient, robotic total gastrectomy with regional lymphadenectomy and thrombectomy were performed. We used the da Vinci Xi Surgical System. A 3-cm incision was made at the umbilicus, and a wound retractor was placed. Five additional ports were placed. The right side suprapancreatic lymph nodes were performed at the time of the thrombectomy. It was important to identify the precise extent of the PVTT with intraoperative ultrasonography before the thrombectomy. After PVTT identification, the portal trunk was clamped above and below the tumor thrombus with vascular clips. The membrane on the anterior wall of the portal trunk around the PVTT was carefully incised with da Vinci Scissors. The tumor thrombus was completely enucleated without separation. The incised part of the portal trunk was reconstructed with continuous 5-0 synthetic monofilament nonabsorbable polypropylene sutures. After removing the vascular clamps, we made sure there was no leakage from the portal vein and no tumor thrombus remnants with intraoperative ultrasonography. Robotic total gastrectomy with lymphadenectomy and Roux-en-Y reconstruction were performed. The patient was discharged without complications. The patient has remained alive for 30 months after surgery.ConclusionsRobotic total gastrectomy with thrombectomy and portal vein reconstruction is a safe, minimally invasive, and precise surgery. It may contribute to improved prognosis of gastric cancer with PVTT when combined with chemotherapy.

【 授权许可】

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