위암. EndoTODAY 이준행

[Gastric cancer 707 - Proximal gastrectomy with double tract reconstruction]

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High body (cardia 직하부) 암 환자입니다. Proximal gastrectomy with double tract reconstruction 수술을 권하였습니다. 결과는 잘 나왔습니다.

(2017, 70대 여성)
Stomach, subtotal proximal gastrectomy: Early gastric carcinoma
1. Location : upper third, Center at body and posterior wall
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, poorly (solid) differentiated
4. Histologic type by Lauren : intestinal
5. Size : 1.3x0.7 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 1.7 cm, distal 4.2 cm
8. Lymph node metastasis : no metastasis in 29 regional lymph nodes (pN0) (0/29: "8a", 0/4; "11p", 0/4; "12a", 0/0; "4sb", 0/0; "1", 0/0; "3", 0/7; "4", 0/0; "7", 0/3; "9", 0/4; "2", 0/0; perigastric LN, 0/7)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Associated findings : gastritis cystica profunda
13. AJCC stage by 8th edition: pT1a N0

수술 과정은 아래와 같았습니다.

Laparoscopic subtotal gastrectomy proximal gastrectomy with double tract reconstruction
. Intracorporeal anastomosis
. Energy device : Harmonic scalpel
. Supine position
. Subumbilical incision 12mm
. Midaxillary line의 Rt upper (5)mm Lt upper (5)mm
. Midclavicular line의 Rt lower (12)mm Lt lower (12)mm
→ Omentectomy was performed (Partial)
→ Distal resection EndoGIA60
→ LN dissection (Yes), D1+β LN dissection with vagotomy
→ Transverse 4cm incision for specimen retrieval
→ Esophageal preparation with reusable
→ Roux-en-Y-esophagojejunostomy with EEA 25 ＋EndoGIA60
→ Jejunojejunostomy with EndoGIA60
→ Frozen section of distal margin (Yes) : (－) with 5cm
→ Frozen section of proximal margin (Yes) : (－) with 3cm
→ Bleeding control and JP catheter insertion 1 at Lt subphrenic
→ Layer by layer closure
→ GJ was done with EndoGIA 60mm x2