Two Cases of Laparoscopic Resection of Siewert Type II Adenocarcinoma of the Esophagogastric Junction Using a Transhiatal Approach and Complicated by Hemopericardium

Abstract

Case series Patients: Male, 67-year-old • Male, 69-year-old Final Diagnosis: Adenocarcinoma of the esophagogastric junction Symptoms: Tachycardia and low blood pressure Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Unusual clinical course Background: Siewert type II adenocarcinoma of the esophagogastric junction is located at the boundary of the distal esophagus and gastric cardia, and surgical resection is currently performed using open or laparoscopic methods. This report presents 2 cases of laparoscopic resection of Siewert type II adenocarcinoma of the esophagogastric junction using a transhiatal approach, complicated by hemopericardium. Case Reports: We present 2 patients diagnosed with Siewert type II esophagogastric junction cancer. A 67-year-old man had intermittent dull pain in the epigastrium without apparent cause for 10 months. A 69-year-old man had persistent dull pain in the middle and upper abdomen for more than 3 months and acid reflux after eating. Gastroscopy with pathological examination confirmed the diagnoses. The patients underwent laparoscopic transhiatal total gastrectomy according to the Japanese Gastric Cancer Treatment Guidelines 2018 (5 th edition). Pathological analysis classified the cancers as T3N1M0 and T2N0M0, respectively. The patients’ cases were complicated with hemopericardium 18 h and 23 h after surgery, respectively. The shared clinical symptoms of the patients included tachycardia and low blood pressure. Cardiovascular color Doppler ultrasound and computed tomography (CT) were used to identify the hemopericardium. Following emergent ultrasound-guided pericardiocentesis and drainage, the vital signs of the patients improved. Both patients recovered well, and no other complications occurred. Conclusions: Hemopericardium is a life-threatening complication for patients with esophageal-gastric junction cancer who undergo transhiatal laparoscopic surgery. Quick detection and intervention for postoperative hemopericardium following laparoscopic transhiatal total gastrectomy are important. Ultrasound-guided pericardiocentesis and drainage is effective for the treatment of postoperative hemopericardium.