Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2015; 21(1): 369-372
Published online Jan 7, 2015. doi: 10.3748/wjg.v21.i1.369
Indocyanine green fluorescence and three-dimensional imaging of right gastroepiploic artery in gastric tube cancer
Toru Nakano, Tadashi Sakurai, Shota Maruyama, Yohei Ozawa, Takashi Kamei, Go Miyata, Noriaki Ohuchi
Toru Nakano, Tadashi Sakurai, Shota Maruyama, Yohei Ozawa, Takashi Kamei, Go Miyata, Noriaki Ohuchi, Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
Author contributions: Nakano T is the main author of this article; Nakano T, Sakurai T, Kamei T and Miyata G were attending doctors and performed clinical treatment including surgical operation; Maruyama S, Ozawa Y and Ohuchi N reviewed the manuscript; all authors have read and approved the final manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toru Nakano, MD, PhD, Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan. torun@med.tohoku.ac.jp
Telephone: +81-22-7177214 Fax: +81-22-7177217
Received: April 24, 2014
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
Abstract

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.

Keywords: Gastrectomy, Indocyanine green, Computed tomography, Mediastinum, Metachronous cancer

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.