title: Subtotal gastrectomy for gastric tube cancer after esophagectomy: a safe procedure preserving the proximal part of gastric tube based on intraoperative ICG blood flow evaluation.
abstract: Recent improvements in the survival of patients after esophagectomy have led to an increase in the occurrence of gastric tube cancer (GTC). Total resection of the gastric tube with lymphadenectomy is a standard and reliable treatment for GTC, but problems may arise during or after surgery, such as laryngeal nerve injury, reduced selection of organs for reconstruction, and impaired swallowing function. We recently performed a less invasive procedure, subtotal gastrectomy with preservation of the upper region of the gastric tube, in two patients. In these patients, blood supply to the gastric tube was evaluated by indocyanine green fluorescence imaging. Blood flow was confirmed as passing from the remnant esophagus to the upper region of the gastric tube through the esophago-gastric anastomotic site by indocyanine green fluorescence imaging. Therefore, we resected the gastric tube while preserving the upper region of the gastric tube. There was no necrosis of the remnant gastric tube or anastomotic leakage postoperatively, and postoperative swallowing and eating functions were quite good in both patients. In summary, subtotal gastrectomy as a treatment for GTC is potentially safe, curative, and beneficial for the patient's quality of life.
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Saito
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Masaaki
authors.initials: M
authors.lastname: Motoori
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kishi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Shingai
authors.forename: Shingo
authors.initials: S
authors.lastname: Noura
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohue
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003679:Deglutition; D016099:Endoscopy, Gastrointestinal; D016629:Esophagectomy / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D020127:Recovery of Function; D013270:Stomach / Q000098:blood supply* / Q000601:surgery*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome