Hereditary diffuse gastric cancer syndrome is an autosomal dominant condition manifesting as a diffuse infiltrating poorly differentiated adenocarcinoma. Seen usually in young adults and results from a mutation in the tumor suppressor gene Spell please (CDH-1) that normally encodes for E-Cadherin. This condition is managed by meticulous regular surveillance for early detection and treatment of gastric cancer followed by prophylactic gastrectomy after certain a age. We present a latero-lateral esophago-jejunal anastomotic technique by means of a linear stapler to reconstruct the gastrointestinal tract.
CASE PRESENTATION
A 37 year old female presented with a family history of gastric cancer that lead to her genetic testing and a diagnosis of Cadherin 1 (CDH-1) mutation. She elected to have a prophylactic gastrectomy and is one of two sisters who had this procedure in our institution. Prior to the gastrectomy, she had an Esophagogastroduodenoscopy (EGD) with multiple biopsies that diagnosed esophagitis and gastritis.
Technique:
A linear stapler was used to transect the distal esophagus (at the GE junction) and the first portion of the duodenum. The frozen section was negative for cancer; a linear stapler was used to create a latero-lateral jejunojejunostomy and a side to side esophagojejunostomy. The anterior wall of the esophagojejunostomy was sealed with running 2-0 vicryl sutures with leak ruled out with air and methylene blue tests.
RESULTS
The patient tolerated the procedure well. A subsequent gastrografin® swallow was negative. She was started on sips of clears on post operative day (POD)#3, advanced as tolerated and discharged on POD#6. She was given adequate genetic counseling and she was advised to follow up with us within 7 – 10 days and with her breast oncologist because of the increased risk of lobular breast cancer. The final pathology report showed negative for cancer.
Conclusion
Laparoscopic total gastrectomy with linear stapler latero-lateral esophagojejunostomy and jejunojejunostomy appears to be a feasible and safe technique.
Session: Video Channel
Program Number: V058