J Korean Surg Soc.  2011 Jun;80(Suppl 1):S1-S5. 10.4174/jkss.2011.80.Suppl1.S1.

Laparoscopy-assisted distal gastrectomy for gastric cancer after liver transplantation

• Lee MS
• Kim EY
• Lee JH
• Jee YS
• Park DJ
• Kim HH
• Kim SY

• KMID: 2096640
• DOI: http://doi.org/10.4174/jkss.2011.80.Suppl1.S1

Abstract

A case report described a 72-year-old man with a history of a deceased-donor liver transplantation (due to hepatitis B-associated end-stage liver cirrhosis) performed in 1994. The patient was diagnosed with renal cell carcinoma and pulmonary metastasis in 1997 and was successfully treated with radiofrequency ablation and thoracoscopic superior segmentectomy. There was no evidence of newly diagnosed metastatic lesions or recurrence until the 19th post-operative month. Gastric cancer was identified by endoscopy during a routine follow-up examination; the pre-pyloric antral lesion measured 1.5 cm in size and was histologically well-differentiated and confined to the submucosal layers on endoscopic ultrasound. Laparoscopic gastrectomy and lymph node dissection (D1 + beta) was successfully performed in March 2009, and the patient was discharged on the 5th post-operative day without complications. This suggests that laparoscopic surgery is one of the feasible methods for resection of gastric cancer in liver transplant patients.

Keyword

Laparoscopic gastrectomy; Liver transplantation; Gastric cancer

MeSH Terms

Aged
Carbamates
Carcinoma, Renal Cell
Endoscopy
Follow-Up Studies
Gastrectomy
Hepatitis
Humans
Laparoscopy
Liver
Liver Transplantation
Lymph Node Excision
Mastectomy, Segmental
Neoplasm Metastasis
Organometallic Compounds
Recurrence
Stomach Neoplasms
Transplants
Carbamates
Organometallic Compounds

Figure

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  Fig. 1 Endoscopic finding after performing biopsies shows early gastric cancer, type IIa + IIc lesion on lesser curvature of the gastric antrum.

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  Fig. 2 Endoscopic ultrasound shows the lesion less than 15 cm with submucosal involvement.

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  Fig. 3 Pre-surgical computed tomography angiography demonstrated the replaced common hepatic artery originating from the superior mesenteric artery. The left gastric artery and the splenic artery originate separately from the celiac axis and the common hepatic artery. A, aorta; White short arrow, proper hepatic artery; White long arrow, replaced common hepatic artery; Black short arrow, gastroduodenal artery; Black long arrow, left gastric artery; Arrowheads, superior mesenteric artery; Curved arrow, splenic artery.

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  Fig. 4 Intra-operative view after dissection of the D1+β lymph node around the celiac axis. P, portal vein; L, divided left gastric artery; S, splenic artery; PH, pancreatic head.

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  Fig. 5 Trocar site placements for the post-liver transplant laparoscopic gastrectomy procedure.

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  Fig. 6 View of the hepaticojejunostomy and the hepatic hilum. HJ, hepaticojejunostomy; LH, left hepatic artery; B, bile duct; P, portal vein; PH, pancreatic head.

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  Fig. 7 This shows schematic drawing after laparoscopic distal gastrectomy. HJ, hepaticojejunostomy; GJ, gastrojejunostomy, DS, duodenal stump; JJ, jejunojejunostomy.

Reference

1. Herrero JI, Alegre F, Quiroga J, Pardo F, Iñarrairaegui M, Sangro B, et al. Usefulness of a program of neoplasia surveillance in liver transplantation: a preliminary report. Clin Transplant. 2009. 23:532–536.

2. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, et al. Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009. 10:44–52.

3. Valero JM, Rubio E, Moreno JM, Pons F, Sanchez-Turrion V, Cuervas-Mons V. De novo malignancies in liver transplantation. Transplant Proc. 2003. 35:709–711.

4. Kim MC, Jung GJ, Kim HH. Morbidity and mortality of laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer. Dig Dis Sci. 2007. 52:543–548.

5. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005. 241:232–237.

6. Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S. Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg. 2000. 135:806–810.

7. Jung IK, Kim MC, Kim KH, Kwak JY, Jung GJ, Kim HH. Cellular and peritoneal immune response after radical laparoscopy-assisted and open gastrectomy for gastric cancer. J Surg Oncol. 2008. 98:54–59.

8. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma - 2nd English edition. Gastric Cancer. 1998. 1:10–24.

9. An JY, Baik YH, Choi MG, Noh JH, Sohn TS, Kim S. Predictive factors for lymph node metastasis in early gastric cancer with submucosal invasion: analysis of a single institutional experience. Ann Surg. 2007. 246:749–753.

10. Hwang SH, Park do J, Jee YS, Kim HH, Lee HJ, Yang HK, et al. Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. J Am Coll Surg. 2009. 208:186–192.