Srikanth Gadiyaram, Dr, Gaurav Singh, Dr, Yashas H Ramegowda, Dr. Sahasra Hospitals, Center of Excellence for Gastroenterology
Background: Surgery remains the mainstay of treatment for neuroendocrine tumors of stomach with resectable liver metastasis. Distal gastrectomy with lymphnodal dissection is increasingly being performed laparoscopically by several centres across the world. Also, laparoscopic left hepatectomy is being performed laparoscopically in some centres routinely. We herein present an operative video of laparoscopic synchronous resection, viz; laparoscopic distal gastrectomy with lymphnode dissection and left hepatectomy.
Case report: 65 year old lady evaluated with upper gastroscopy for evaluation of upper abdominal pain had a antral tumor which was confirmed to be a carcinoid tumor on histopathology and immunohistochemistry. A DOTANOC-PETCT showed an increased uptake in gastric antral lesion, hepato-duodenal enlarged lymphnodes and uptake in lesions in Segment 2, 3 and 4 of liver and no uptake elsewhere. The patient was planned for the aforementioned operative procedure which was performed in the following steps
Step 1 – Five port laparoscopic procedure. Lesser sac was opened, right gastroepiploic vessels dissected and divided. First part of duodenum looped and staple transected
Step 2 – Hepatoduodenal lymphnode clearance done
Step 3 – Left hepatic artery looped, ligated and divided. Left portal vein looped and ligated in continuity
Step 4 – Line of demarcation marked out. Parenchymal transection done using harmonic for superficial transection, CUSA for deeper parenchymal transection, and structures 3 mm or more clipped and divided. The left portal pedicle was staple (endo GIA vascular load) transected, and left hepatic vein encountered during deeper dissection, was dissected and secured with an endo GIA vascular load. The left triangular ligament was divided.
Step 5 – Proximal gastric marging for transection defined, and staple divided
Step 6 – Specimen retrieval, viz; distal stomach, lymphnodes and left liver placed in endobag and removed through 5 cm left subcostal incision.
Step 7 – Gastrojejunostomy completed through the wound of specimen retrieval
Step 8 – Hemostasis checked , lavage done and drain placed along transected liver and excited from right anterior axillary line port.
Conclusions: Synchronous laparoscopic gastrectomy and major hepatectomy is safe and feasible. This has to be viewed keeping in mind the potential need for repeat surgeries in these patients in the long term for any recurrent disease.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93928
Program Number: P506
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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