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Laparoscopic Conversion Surgery After Three Years of Palliative Chemotherapy for Unresectable Advanced Gastric Cancer

Laparoscopic Conversion Gastrectomy

Article information

J Surg Innov Educ. 2024;1(1):26-27
Publication date (electronic) : 2024 June 25
doi : https://doi.org/10.69474/jsie.2024.00073
Ma. Jeanesse C. Bernardo1,2orcid_icon, Mohd Firdaus Che Ani2,4orcid_icon, Zhuang Chun2,5orcid_icon, Abdullah Almayouf2,6, Jee-sun Kim2,3orcid_icon, Tae-Yong Kim7, Seong-Ho Kong2,3orcid_icon, Do-Joong Park2,3orcid_icon, Han-Kwang Yang2,3orcid_icon, Hyuk-Joon Lee,2,3orcid_icon
1Department of Surgery, Chinese General Hospital and Medical Center, Metro Manila, Philippines
2Division of Gastrointestinal Surgery, Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
3Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
4Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
5Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
6Department of Surgery, King Saud Hospital, Qassim, Saudi Arabia
7Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Corresponding author: Hyuk-Joon Lee, MD, PhD Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine; Division of Gastrointestinal Surgery, Seoul National University Hospital; Gastric Cancer Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea Tel: +82-2-2072-1957, E-mail: appe98@snu.ac.kr
Received 2024 June 17; Revised 2024 June 20; Accepted 2024 June 20.

Abstract

Unresectable advanced gastric cancer remains a challenge in treatment, often requiring a multidisciplinary approach. Numerous studies have emphasized the role of palliative chemotherapy as the mainstay treatment for unresectable advanced gastric cancers. Some patients may still require conversion surgery to achieve survival gain and palliation. Several recent papers have shown the safety of laparoscopic gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer. However, there is a difference between neoadjuvant chemotherapy and palliative chemotherapy in terms of the duration of chemotherapy (about 3 months vs. more than 6 months) and the initial state of advanced gastric cancer (resectable vs. unresectable and/or metastatic). To date, the safety and efficacy of laparoscopic gastrectomy after long-term palliative chemotherapy has been rarely reported. This video aims to share our experience in performing laparoscopic distal gastrectomy with D2 lymph node dissection after 3 years of palliative chemotherapy for an unresectable advanced gastric cancer.

Chapter Summary

00:00:01 Introduction

00:00:10 Case summary

00:00:26 History of present illness

00:00:30 Initial chemotherapy endoscopy

00:00:36 Radiology: initial CT scan (snapshot)

00:01:04 Preoperative work-up: repeat endoscopy

00:01:09 Preoperative work-up: repeat CT scan

00:01:20 Liver retraction

00:01:53 Marking of anatomical structures

00:02:00 Gastrocolic dissection

00:02:24 Division of the left gastro-epiploic vessels

00:02:46 Total omentectomy

00:02:56 Infra-pyloric dissection

00:03:28 Division of the right gastro-epiploic and infra-pyloric vessels

00:04:48 Supra-pyloric dissection

00:05:12 Division of the right gastric artery

00:05:30 Division of duodenum

00:05:48 Supra-pancreatic lymph node dissection

00:08:10 Division of the left gastric artery

00:10:14 Dissection of proximal lesser curvature

00:10:19 Proximal gastric transection

00:10:59 Billroth II reconstruction

00:12:13 Course in the wards

00:12:33 Specimen

00:12:36 Pathology report

Notes

Disclosure

Hyuk-Joon Lee is the president of the Korean Surgical Skill Study Group and Seong-Ho Kong is an editorial board member of the journal, but they were not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

References

1. Kinoshita J, Yamaguchi T, Moriyama H, Fushida S. Current status of conversion surgery for stage IV gastric cancer. Surg Today 2021;51:1736–1754.
2. Li Z, Shan F, Ying X, Zhang Y, E JY, Wang Y, et al. Assessment of laparoscopic distal gastrectomy after neoadjuvant chemotherapy for locally advanced gastric cancer: a randomized clinical trial. JAMA Surg 2019;154:1093–1101.
3. Zhang F, Huang X, Song Y, Gao P, Zhou C, Guo Z, et al. Conversion surgery for stage IV gastric cancer. Front Oncol 2019;9:1158.

Article information Continued

© 2024 Korean Surgical Skill Study Group

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