Robotic distal gastrectomy for advanced gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery

IF 0.2 4区医学 Q4 SURGERY

International surgery Pub Date : 2021-01-25 DOI:10.9738/INTSURG-D-20-00040.1

T. Yoshimoto, K. Yoshikawa, M. Shimada, Jun Higashijima, T. Tokunaga, M. Nishi, C. Takasu, H. Kashihara, Shohei Eto

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引用次数: 0

Abstract

Introduction: The right gastroepiploic artery (RGEA) is used in coronary artery bypass grafting (CABG). However, the treatment of gastric cancer after CABG using the RGEA is complex, as stopping coronary blood flow from the RGEA may cause lethal myocardial ischemia. Adequate treatment must strike a balance between the curability and safety. Case presentation: The patient was a 79-year-old man with advanced gastric cancer who had previously undergone CABG with the RGEA. It was impossible to perform curative gastrectomy with preservation of the RGEA. Thus, percutaneous coronary intervention was performed to revascularize the native right coronary artery. The patient then started chemotherapy using oxaliplatin and S-1. After four courses of chemotherapy, the patient underwent robotic distal gastrectomy with D2 lymphadenectomy, including regional lymph node dissection around the RGEA. The RGEA was cut after a clamp test confirmed that there was no ST change. Conclusion: In patients who develop gastric cancer after CABG using the RGEA, percutaneous coronary intervention of the native coronary artery is useful when resection of the RGEA is required to dissect the no. 6 lymph node. Robotic gastrectomy is a surgical option in such cases.

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右胃网膜动脉冠状动脉旁路移植术后晚期胃癌机器人远端胃切除术

简介:右胃网膜动脉(RGEA)用于冠状动脉旁路移植术(CABG)。然而，使用RGEA治疗CABG后的胃癌是复杂的，因为停止RGEA的冠状动脉血流可能导致致死性心肌缺血。适当的治疗必须在可治愈性和安全性之间取得平衡。病例介绍:患者是一名79岁的晚期胃癌患者，曾接受过RGEA的CABG手术。保留RGEA是不可能进行根治性胃切除术的。因此，经皮冠状动脉介入治疗是为了重建原有的右冠状动脉。然后患者开始使用奥沙利铂和S-1化疗。化疗4个疗程后，患者行机器人远端胃切除术并D2淋巴结切除术，包括RGEA周围的区域淋巴结清扫。在钳形测试确认无ST改变后，切割RGEA。结论:对于采用RGEA进行胃癌冠脉搭桥术后发生胃癌的患者，当需要切除RGEA以解剖肿瘤时，经皮冠状动脉介入治疗是有效的。6淋巴结。在这种情况下，机器人胃切除术是一种手术选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International surgery 医学-外科

CiteScore

0.30

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： International Surgery is the Official Journal of the International College of Surgeons. International Surgery has been published since 1938 and has an important position in the global scientific and medical publishing field. The Journal publishes only open access manuscripts. Advantages and benefits of open access publishing in International Surgery include: -worldwide internet transmission -prompt peer reviews -timely publishing following peer review approved manuscripts -even more timely worldwide transmissions of unedited peer review approved manuscripts (“online first”) prior to having copy edited manuscripts formally published. Non-approved peer reviewed manuscript authors have the opportunity to update and improve manuscripts prior to again submitting for peer review.