Kazuma Sato, Shunji Kinuta, Koichi Takiguchi, Naoyuki Hanari, Naoki Koshiishi. Takeda General Hospital
Background: Situs inversus totalis (SIT) is a rare congenital condition in which the abdominal and thoracic organs are located opposite to their normal positions. Few cases of laparoscopic surgery for gastric cancer with SIT have been reported. We report a case of laparoscopic distal gastrectomy with D2 lymph node dissection performed for gastric cancer in a patient with SIT.
Case Description: An 80-year-old woman was admitted to our hospital for treatment of gastric cancer that was diagnosed by esophagogastroduodenoscopy (EGD) at a local clinic after she experienced anemia and nausea. EGD identified an irregularly shaped gastric ulcer located at the anterior side of the lesser curvature of the antrum. A biopsy revealed a moderately differentiated adenocarcinoma. She was then diagnosed with SIT by chest radiography and abdominal computed tomography (CT). The abdominal CT showed that all organs were inversely positioned and that the wall of the antrum had thickened; it also showed the lymph nodes in the lesser curvature of the stomach, without distant metastasis or an abnormal course of vascularity. The patient was clinically diagnosed with T3N1M0 stage IIIA gastric cancer according to the Japanese Classification of Gastric Carcinoma. A laparoscopic distal gastrectomy with D2 lymph node dissection in accordance with the Japanese Gastric Cancer Treatment Guidelines as well as a Roux-en-Y anastomosis due to an esophageal hiatal hernia were performed. The surgery was safely and successfully performed, although it required more time than usual because the inverted anatomic structures were repeatedly examined during the surgery. The postoperative course was positive, and the patient was discharged on postoperative day 7 without any complications. The final stage of this case was pT1bN0M0 stage IA. Currently, the patient is doing well without recurrent gastric cancer.
Conclusion: Gastric cancer with SIT is an extremely rare occurrence. We experienced a case of laparoscopic distal gastrectomy with D2 lymph node dissection performed for gastric cancer in a patient with SIT. We simulated the operation for SIT by viewing left-right reversed ordinary surgical videos. The abdominal CT angiography with a three-dimensional reconstruction helped reveal any variation and confirmed the structures and locations of vessels before the surgery. The operation could safely be performed following the standardized surgical technique by reversing the surgeon standing position and trocar position.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87186
Program Number: P179
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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