Laparoscopic Distal Gastrectomy for Synchronous Gastric Cancer and Gastrointestinal Stromal Tumor With Situs Inversus Totalis

Namikawa, Tsutomu; Yokota, Keiichro; Tanioka, Nobuhisa; Iwabu, Jun; Munekage, Masaya; Uemura, Sunao; Maeda, Hiromichi; Kitagawa, Hiroyuki; Nagata, Yusuke; Kobayashi, Mariko; Hanazaki, Kazuhiro

doi:10.21873/invivo.12331

Cited by 13 publications

(12 citation statements)

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“…The higher the risk, the more irregular the shape; the more uneven the internal density and the greater the probability of necrosis, liquefaction, and bleeding. These results are consistent with those of this study[ 8 , 9 ].…”

Section: Discussionsupporting

confidence: 94%

Multi-slice spiral computed tomography in differential diagnosis of gastric stromal tumors and benign gastric polyps, and gastric stromal tumor risk stratification assessment

Li¹,

Han²,

Wang³

et al. 2022

World J Gastrointest Oncol

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BACKGROUND The biological characteristics of gastric stromal tumors are complex, and their incidence has increased in recent years. Gastric stromal tumors (GST) have potential malignant tendencies, and the probability of transformation into malignant tumors is as high as 20%-30%. AIM To investigate the value of multi-slice spiral computed tomography (MSCT) in the differential diagnosis of GST and benign gastric polyps, and GST risk stratification assessment. METHODS We included 64 patients with GST (GST group) and 60 with benign gastric polyps (control group), confirmed by pathological examination after surgery in PLA General Hospital, from January 2016 to June 2021. The differences in the MSCT imaging characteristic parameters and enhanced CT values between the two groups before surgery were compared. According to the National Institutes of Health’s standard, GST is divided into low- and high-risk groups for MSCT imaging characteristic parameters and enhanced CT values. RESULTS The incidences of extraluminal growth, blurred boundaries, and ulceration in the GST group were significantly higher than those in the control group ( P < 0.05). The CT values and enhanced peak CT values in the arterial phase in the CST group were higher than those in the control group ( P < 0.05). The MSCT differential diagnosis of GST and gastric polyp sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and areas under the curve (AUCs) were 73.44 %, 83.33%, 26.56%, 16.67%, 0.784, respectively. The receiver operating characteristic curves were plotted with the arterial CT value and enhanced peak CT value, with a statistical difference. The results showed that the sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and AUC value of arterial CT in the differential diagnosis of GST and gastric polyps were 80.18%, 62.20%, 19.82%, 37.80%, and 0.710, respectively. The sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and AUC value of the enhanced peak CT value in the differential diagnosis of GST and gastric polyps were 67.63%, 60.40%, 32.37%, 39.60%, and 0.710, respectively. The incidence of blurred lesion boundaries and ulceration in the high-risk group was significantly higher than that in the low-risk group ( P < 0.05). The arterial phase and enhanced peak CT values in the high-risk group were significantly higher than those in the low-risk group ( P < 0.05). CONCLUSION Presurgical MSCT examination has important value in the differential diagnosis of GST and gastric benign polyps and can effectively evaluate the risk grade of GST patients.

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Section: Discussionsupporting

confidence: 94%

Multi-slice spiral computed tomography in differential diagnosis of gastric stromal tumors and benign gastric polyps, and gastric stromal tumor risk stratification assessment

Li¹,

Han²,

Wang³

et al. 2022

World J Gastrointest Oncol

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“…Vascular aberrations have been commonly found in patients with SIT. Preoperative imaging, such as 3D reconstructive CT angiography, can be used to identify anatomical variations in arteries and veins [22,[25][26][27][28][29] and ascertain anatomy that can cause further complications [25]. Careful assessment of vascular anomalies can help prevent complications such as injury to the blood vessels, bleeding, and pancreatic injury [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

“…Tere is currently consensus on the side from which a surgeon should operate in laparoscopic surgery of SIT patients. To avoid confusion created by the altered anatomy of SIT patients, some surgeons reversed their positions and port placement to allow for adaptation to the mirror-image anatomy [9,22,23,25,28,30,31], while others retained the standard positions and port placement [10,11,27,32]. If standing on the opposite side, the surgeon should be able to use their nondominant hand sufciently well to handle instruments [9,25,26,29].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic vs. Robotic Gastrectomy in Patients with Situs Inversus Totalis: A Systematic Review

Multani

Parmar

Dixon

2023

Minimally Invasive Surgery

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Background. Situs inversus totalis (SIT) is a rare genetic anomaly involving the mirror-image transposition of organs. This transposition can potentially make surgical treatments difficult because of the reversed anatomy and intraoperative confusion. The aim of this systematic review is to compare the perioperative outcomes and safety of robotic and laparoscopic gastrectomy in patients with SIT. Methods. We included full-text case reports with brief reviews and standalone case studies on SIT patients age ≥21, undergoing laparoscopic or robotic gastrectomy. We excluded case studies focusing on procedures other than laparoscopic and robotic gastrectomy, namely, open gastrectomy, gastric banding, and gastric bypass. English was selected as the language and articles published in the last 10 years were selected with a date range from Jan, 2011, to Aug, 2021. We focused on intraoperative and postoperative outcomes including blood loss, vascular aberrancy, operation duration, mortality, operative complications, duration of hospitalization, and follow-up interval. Online databases included Clinical Key, Embase, ScienceDirect, Ovid, and Google Scholar. The last search was conducted on Aug 15, 2021. For all eligible articles, risk of bias assessment was carried out using JBI critical appraisal checklist (Table 1). Continuous data were analyzed using t-test with p value of 0.05. Results. From our search, we retained 29 case reports which reported information from 30 cases. The results reported in each study were summarized (Table 2). The laparoscopic procedure was used in 21 cases and robot-assisted surgery was used in 9 cases. Operative time was mentioned in 24 out of the 30 cases and the average operative time was 205.67 min. Blood loss was reported in 16 out of the 30 cases, with an average blood loss of 51.9 mL. Hospital stay information was provided in 26 out of the 30 cases, with an average length of stay of 8.5 days. A statistically significant difference was not found for the operative time, length of hospitalization, or age of the patient. However, intraoperative blood loss in robot-assisted gastrectomy was lower compared to laparoscopic gastrectomy, with a p value of 0.0293. Perioperative death was not reported in any of the cases. Only three cases of postoperative complications were reported in laparoscopic surgery. Only one of the three cases suggested that the complication was due to an anomaly, whereas the other two of them reported complications due to procedural errors. Conclusion. Laparoscopic and robotic gastrectomy can be safely used for SIT patients if performed cautiously. Some precautions include thoroughly assessing anatomical aberrations using preoperative imaging, adjusting the operative set up, and having experienced surgeons. The robotic approach may have a few advantages over laparoscopic procedures that may enhance the surgical safety for SIT patients and need to be further explored in future research. Advantages of the robotic approach may include improved surgical safety with better visualization of the surgical field, promoting the stability of surgical instruments and perhaps allowing ease of surgical orientation and positioning when operating on patients with SIT. Further research in this field is merited.

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“…The characteristics of patients with SIT and advanced gastric cancer who underwent laparoscopic gastrectomy were found in four previous reports. These case reports are listed in Table 1 [3][4][5][6]. Three of the listed cases had vessel abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…Although a recent randomized controlled trial (RCT) revealed that laparoscopic gastrectomy for gastric cancer had become a standard procedure especially for clinical stage I cancer [2], this procedure is technically demanding owing to the anatomical anomalies in patients with SIT. There are several reports on laparoscopic gastrectomy for SIT; however, only a few reports have presented laparoscopic gastrectomy for patients with advanced gastric cancer with SIT [3][4][5][6], which is considered a complex procedure because of the additional requirement for D2 lymph node dissection. Previous reports regarding the management of advanced disease pertained to patients with SIT who did not have lymph node metastases on clinical assessment.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic distal gastrectomy for advanced gastric cancer with situs inversus totalis: a case report

et al. 2022

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Background Situs inversus totalis (SIT) is a relatively rare condition, in which the thoracic and abdominal organs are reversed or mirrored from their normal positions. Here, we reported a case of a patient with SIT and advanced gastric cancer with lymph node metastasis who underwent laparoscopic distal gastrectomy (LDG). Case presentation A 67-year-old man with SIT was clinically diagnosed with T3N2M0 advanced gastric cancer located in the middle gastric body. Three-dimensional reconstruction of computed tomography angiogram revealed that the common hepatic artery originated from the superior mesenteric artery. The patient underwent LDG with D2 lymph node dissection and Roux-en-Y reconstruction. The postoperative course was uneventful. Conclusion This case report showed that LDG could be safely performed on a patient even under complex conditions, such as advanced gastric cancer with lymph node metastasis with SIT and vascular anomalies.

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Laparoscopic Distal Gastrectomy for Synchronous Gastric Cancer and Gastrointestinal Stromal Tumor With Situs Inversus Totalis

Cited by 13 publications

References 0 publications

Multi-slice spiral computed tomography in differential diagnosis of gastric stromal tumors and benign gastric polyps, and gastric stromal tumor risk stratification assessment

Multi-slice spiral computed tomography in differential diagnosis of gastric stromal tumors and benign gastric polyps, and gastric stromal tumor risk stratification assessment

Laparoscopic vs. Robotic Gastrectomy in Patients with Situs Inversus Totalis: A Systematic Review

Laparoscopic distal gastrectomy for advanced gastric cancer with situs inversus totalis: a case report

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