Published online Jan 7, 2015. doi: 10.3748/wjg.v21.i1.369
Peer-review started: April 25, 2014
First decision: May 29, 2014
Revised: June 19, 2014
Accepted: July 15, 2014
Article in press: July 16, 2014
Published online: January 7, 2015
A 79-year-old male was admitted to our hospital for the treatment of cancer of the gastric tube. Gastrointestinal examination revealed a T1b Union for International Cancer Control (UICC) tumor at the pyloric region of the gastric tube. Laparotomy did not reveal infiltration into the serosa, peritoneal dissemination, regional lymph node swelling, or distant metastasis. We performed a distal gastrectomy preserving the right gastroepiploic artery by referencing the preoperative three-dimensional computed tomoangiography. We also evaluated the blood flow of the right gastroepiploic artery and in the proximal gastric tube by using indocyanine green fluorescence imaging intra-operatively and then followed with a gastrojejunal anastomosis with Roux-en-Y reconstruction. The definitive diagnosis was moderately differentiated adenocarcinoma of the gastric tube, pT1bN0M0, pStage IA (UICC). His postoperative course was uneventful. Three-dimensional computed tomographic imaging is effective for assessing the course of blood vessels and the relationship with the surrounding structures. Intraoperative evaluation of blood flow of the right gastroepiploic artery and of the gastric tube in the anastomotic portion is very valuable information and could contribute to a safe gastrointestinal reconstruction.
Core tip: A report of a 79-year-old male who presented with a metachronous gastric tube cancer following an esophageal squamous cell carcinoma. It is necessary for less invasive surgery as the resection of the distal part of the tube to prevent right gastroepiploic artery. Curative resection of the distal part of the gastric tube was performed while safely preserving the right gastroepiploic artery by referencing the preoperative three-dimensional computed tomoangiography. The intraoperative evaluation of blood flow by using indocyanine green fluorescence imaging contributed critical information about the blood flow of right gastroepiploic artery and gastric tube; we then followed with the Roux-en-Y reconstruction.