Laparoscopic total gastrectomy, omentectomy, splenectomy for gastric adenocarcinoma

Gautam Sharma, MD, James Villamere, MD, Mena Boules, MD, John Rodriguez, MD, Matthew Kroh, MD. Cleveland Clinic Foundation

Introduction: Laparoscopic Total Gastrectomy with D2 Lymphadenectomy is common in Eastern Asia, however it’s still underutilized in North America.

Methods: We present the case of a 76 year old male who underwent Screening Upper GI Endoscopy for Pernicious anemia. He was found to have a small mass in the fundus of stomach. Biopsies obtained at the time of endoscopy were diagnostic for moderately differentiated Adenocarcinoma.

The patient underwent diagnostic laparoscopy to check the resectability of the tumor. There were no distant metastases identified. Total gastrectomy with D2 lymphadenectomy was performed. Additionally splenectomy was carried out due to inflammation at the splenic hilum. This was followed by Roux-en-Y Esophago-Jejunostomy.

Results: Laparoscopic Total Gastrectomy with D2 lymphadenectomy, and omentectomy was successfully completed. Surgical Pathology showed moderately differentiated Adenocarcinoma with metastasis in 4/28 lymph nodes. No evidence of tumor was found in the omentum, spleen, and lymph nodes. Stage 2 (T2N1M0, AJCC). Patient was discharged on POD #6 in stable condition.

Conclusion: Completely Laparoscopic Total Gastrectomy with D2 Lymphadenectomy with Esophago-Jejunostomy is technically feasible with excellent short-term outcomes.

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