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Case Reports
. 2021 Dec 24;2021(12):rjab574.
doi: 10.1093/jscr/rjab574. eCollection 2021 Dec.

Distal partial gastrectomy for gastric tube cancer with intraoperative blood flow evaluation using indocyanine green fluorescence

Ayano Sakai  1 , Tomoyuki Okumura  1 , Takeshi Miwa  1 , Toru Watanabe  1 , Yoshihisa Numata  1 , Misato Araki  1 , Ayaka Ito  1 , Emi Kanaya  1 , Taro Sakurai  1 , Mina Fukazawa  1 , Yui Hoshino  1 , Yuuko Tohmatsu  1 , Ryutaro Tokai  1 , Hayato Baba  1 , Katsuhisa Hirano  1 , Takamichi Igarashi  1 , Isaya Hashimoto  1 , Kazuto Shibuya  1 , Shozo Hojo  1 , Koshi Matsui  1 , Isaku Yoshioka  1 , Tsutomu Fujii  1
Affiliations
Case Reports

Distal partial gastrectomy for gastric tube cancer with intraoperative blood flow evaluation using indocyanine green fluorescence

Ayano Sakai et al. J Surg Case Rep. .

Abstract

With recent advances in the treatment of esophageal cancer and long-term survival after esophagectomy, the number of gastric tube cancer (GTC) has been increasing. Total gastric tube resection with lymph node dissection is considered to be a radical treatment, but it causes high post-operative morbidity and mortality. We report an elderly patient with co-morbidities who developed pyloric obstruction due to GTC after esophagectomy with retrosternal reconstruction. The patient was treated using distal partial gastric tube resection (PGTR) and Roux-en-Y reconstruction with preservation of the right gastroepiploic artery and right gastric artery. Intraoperative blood flow visualization using indocyanine green (ICG) fluorescence demonstrated an irregular demarcation line at the distal side of the preserved gastric tube, indicating a safe surgical margin to completely remove the ischemic area. PGTR with intraoperative ICG evaluation of blood supply in the preserved gastric tube is a safe and less-invasive surgical option in patients with poor physiological condition.

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Figures

Figure 1
Figure 1
Upper gastrointestinal endoscopy showed a tumor at the pyloric region of the gastric tube causing pyloric obstruction.
Figure 2
Figure 2
Preoperative CT image; white arrows indicate a tumor with thickening of the gastric wall.
Figure 3
Figure 3
Diagrammatic representation of the intraoperative findings; (A) resection of the distal gastric tube with preservation of the RGEA and RGA and (B) Roux-en-Y reconstruction; SDA, supra-duodenal artery; p-ring, pyloric ring.
Figure 4
Figure 4
Intraoperative visualization of the blood flow in the proximal side of the gastric tube using ICG fluorescence; bilateral arrow: dissection line of the proximal margin; black dotted line: outline of the proximal part of the gastric tube; black solid line: distal surgical margin; white dotted line: pylorus; black dotted circle: location of the tumor.
Figure 5
Figure 5
Resected specimen; a Type II tumor in the pyloric lesion of the gastric tube measuring 25 × 15 mm in size; PM, proximal margin; DM, distal margin; asterisk, surgical specimen removed by circular staple.
See this image and copyright information in PMC

References

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