A Case of a very young female gastric cancer patient undergoing Laparoscopic total gastrectomy with Roux-en-Y anastomosis under a 3D camera.

A Case of a very young female gastric cancer patient undergoing Laparoscopic total gastrectomy with Roux-en-Y anastomosis under a 3D camera. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A Case of a very young female gastric cancer patient undergoing Laparoscopic total gastrectomy with Roux-en-Y anastomosis under a 3D camera. Md Rasadul Hasan, Bo Sun-Shi, Yan Sun, Ning Chen-Xiao, Qiang Li, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6510402/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The oncologic outcomes of laparoscopy-assisted gastrectomy for the treatment of gastric cancer have not been evaluated. This study aims to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer in terms of long-term survival. Laparoscopic gastrectomy has become widely used for the treatment of early gastric cancer in China; the feasibility of laparoscopic distal gastrectomy in particular has been assessed in several studies.[1, 2] However, laparoscopic procedures are more challenging in patients with previous abdominal surgery because of a higher risk of enteric injury, technical difficulties associated with adhesions, and longer operative times. In terms of the recent advantages of the laparoscopic technique, several reports have presented the usefulness of the laparoscopic approach for patients with remnant gastric cancer following radical distal gastrectomy.[3-6] Here, we present a case of laparoscopic total gastrectomy following Roux-en-Y anastomosis. Gastrointestinal Surgery gastric cancer total gastrectomy Roux-en-Y anastomosis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The oncologic outcomes of laparoscopy-assisted gastrectomy for the treatment of gastric cancer have not been evaluated. This study aims to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer in terms of long-term survival. Laparoscopic gastrectomy has become widely used for the treatment of early gastric cancer in China; the feasibility of laparoscopic distal gastrectomy in particular has been assessed in several studies.[ 1 , 2 ] However, laparoscopic procedures are more challenging in patients with previous abdominal surgery because of a higher risk of enteric injury, technical difficulties associated with adhesions, and longer operative times. In terms of the recent advantages of the laparoscopic technique, several reports have presented the usefulness of the laparoscopic approach for patients with remnant gastric cancer following radical distal gastrectomy.[ 3 – 6 ] Here, we present a case of laparoscopic total gastrectomy following Roux-en-Y anastomosis. Case Presentation A 26-year-old Chinese woman presented to our department with a chief complaint of epigastric pain for half a year. Half a year ago, she did not feel obvious pain, at first she did not care, and she received no treatment. Eight days before her pain worsened, she went to a local hospital, where Gastroscopy showed huge ulcers, about 2.0*2.4cm. The pathology report shows a low rate of gastric cancer. She did not have any other diseases, no heart diseases; her family members are all healthy. She came to our department for further diagnosis and treatment. The CT scan showed the distal gastric wall thickening, the thickest place being 24mm. It also showed multiple small stomach-wound lymph nodes. A clinical diagnosis of gastric cancer according to the Classification of Gastric Carcinoma, T4N3M2 stage. A laparoscopic approach was selected for Total gastrectomy under a 3D camera. Methods/ Procedure In this case, we made two critical clinical observations. First, we made a 3D clear view of the abdominal cavity images of a gastric cancer patient preoperatively. The second was successfully performed in our hospital. It was a laparoscopic total gastrectomy with Roux-en-Y anastomosis. The surgery was carried out with five ports (10mm,5mm,12mm,5mm,5mm) by the pneumoperitoneal method using our usual laparoscopic technique. The surgeon stood on the left side of the patient. In the general inspection of the abdominal cavity, we saw a metastasis area on the right abdominal wall, along the duodenum, and lymph node metastasis around the pancreas. Rapid biopsy of the left abdominal wall tissue shows tumor cells in the striated muscle that tend to be poorly differentiated carcinoma. At initial laparoscopy, there was a little adhesion in the median abdominal incision. At first, adhesion was removed as much as possible, and the omentum was dissected to open the bursa. There was a lymph node metastasis near the pancreas. We tried to avoid any kind of injury to the pancreas and removed as much as possible. The right gastroepiploic artery and vein were clipped and divided. After dividing the right gastric artery, the duodenum was transected using a linear stapler (GIA_ Tri Staple_ 60 mm, purple 60 mm). Then the lesser and greater curvature artery and vein were clipped toward the cardia and esophagus. A mini-laparotomy incision of about 5 cm was made in the epigastric area, for a Reconstruction using the Roux-en-Y method via the antecolic route was performed. The abdominal esophagus had been scarified circumferentially, and the esophagus was transected using a linear stapler on the proximal side of the anastomosis of the esophagojejunostomy at initial proximal gastrectomy. After gastrectomy, the reconstructed jejunum was resected. At first, esophagojejunostomy was performed by an end-to-side anastomosis using a circular stapler (DST Series_ EEA_ Staplers, 25 mm, Covidien). Next, jejunojejunostomy was carried out by side-to-side anastomosis using an extracorporeal linear stapler. Total operation time was 3 hours, and total blood loss was 150 to 200 ml. Conclusion We have described a good result of a laparoscopic approach for total gastrectomy for gastric cancer following Roux-en-Y anastomosis. A literature review supports a minimally invasive approach for this procedure, showing that laparoscopic 3D view total gastrectomy is safer, more effective, and technically feasible. Declarations A statement on participant consent The protocol for this research project has been approved by The Second Affiliated Hospital of Harbin Medical University review Committee, which approved the investigation. The patients read this study's protocol forms and signed written informed consent. Funding acquisition: This research received no external funding. Conflicts of interest. No Conflicts of interest. Ethical statement The protocol for this research project has been approved by the Ethics Committee of the Second Affiliated Hospital of Harbin Medical University, which approved the investigation. Patients in this study signed written informed consent. References Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Soga R, et al. Completely laparoscopic extraperigastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach. Gastric Cancer. 1999;2(3):186-90. Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer. 2010;13(4):238-44. Fujikawa H, Yoshikawa T, Aoyama T, Hayashi T, Cho H, Ogata T, et al. Laparoscopy-assisted distal gastrectomy for an early gastric cancer patient with situs inversus totalis. Int Surg. 2013;98(3):266-70. Min SH, Lee CM, Jung HJ, Lee KG, Suh YS, Shin CI, et al. Laparoscopic distal gastrectomy in a patient with situs inversus totalis: a case report. J Gastric Cancer. 2013;13(4):266-72. Fonkalsrud EW, Tompkins R, Clatworthy HW, Jr. Abdominal manifestations of situs inversus in infants and children. Arch Surg. 1966;92(5):791-5. Machado NO, Chopra P. Laparoscopic cholecystectomy in a patient with situs inversus totalis: feasibility and technical difficulties. Jsls. 2006;10(3):386-91. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6510402","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":446781012,"identity":"9bf5c993-7d0c-451b-8ce3-4e52bd092f67","order_by":0,"name":"Md Rasadul Hasan","email":"","orcid":"https://orcid.org/0009-0002-0112-7639","institution":"The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China","correspondingAuthor":false,"prefix":"","firstName":"Md","middleName":"Rasadul","lastName":"Hasan","suffix":""},{"id":446781013,"identity":"e983243b-696a-450f-9a04-932c4dc0526a","order_by":1,"name":"Bo 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evaluated. This study aims to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer in terms of long-term survival. Laparoscopic gastrectomy has become widely used for the treatment of early gastric cancer in China; the feasibility of laparoscopic distal gastrectomy in particular has been assessed in several studies.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] However, laparoscopic procedures are more challenging in patients with previous abdominal surgery because of a higher risk of enteric injury, technical difficulties associated with adhesions, and longer operative times. In terms of the recent advantages of the laparoscopic technique, several reports have presented the usefulness of the laparoscopic approach for patients with remnant gastric cancer following radical distal gastrectomy.[\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Here, we present a case of laparoscopic total gastrectomy following Roux-en-Y anastomosis.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 26-year-old Chinese woman presented to our department with a chief complaint of epigastric pain for half a year. Half a year ago, she did not feel obvious pain, at first she did not care, and she received no treatment. Eight days before her pain worsened, she went to a local hospital, where Gastroscopy showed huge ulcers, about 2.0*2.4cm. The pathology report shows a low rate of gastric cancer. She did not have any other diseases, no heart diseases; her family members are all healthy.\u003c/p\u003e\n\u003cp\u003eShe came to our department for further diagnosis and treatment. The CT scan showed the distal gastric wall thickening, the thickest place being 24mm. It also showed multiple small stomach-wound lymph nodes.\u003c/p\u003e\n\u003cp\u003eA clinical diagnosis of gastric cancer according to the Classification of Gastric Carcinoma, T4N3M2 stage. A laparoscopic approach was selected for Total gastrectomy under a 3D camera.\u003c/p\u003e"},{"header":"Methods/ Procedure","content":"\u003cp\u003eIn this case, we made two critical clinical observations. First, we made a 3D clear view of the abdominal cavity images of a gastric cancer patient preoperatively. The second was successfully performed in our hospital. It was a laparoscopic total gastrectomy with Roux-en-Y anastomosis. The surgery was carried out with five ports (10mm,5mm,12mm,5mm,5mm) by the pneumoperitoneal method using our usual laparoscopic technique. The surgeon stood on the left side of the patient. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003eIn the general inspection of the abdominal cavity, we saw a metastasis area on the right abdominal wall, along the duodenum, and lymph node metastasis around the pancreas. Rapid biopsy of the left abdominal wall tissue shows tumor cells in the striated muscle that tend to be poorly differentiated carcinoma. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt initial laparoscopy, there was a little adhesion in the median abdominal incision. At first, adhesion was removed as much as possible, and the omentum was dissected to open the bursa. There was a lymph node metastasis near the pancreas. We tried to avoid any kind of injury to the pancreas and removed as much as possible. The right gastroepiploic artery and vein were clipped and divided. After dividing the right gastric artery, the duodenum was transected using a linear stapler (GIA_ Tri Staple_ 60 mm, purple 60 mm). Then the lesser and greater curvature artery and vein were clipped toward the cardia and esophagus. A mini-laparotomy incision of about 5 cm was made in the epigastric area, for a Reconstruction using the Roux-en-Y method via the antecolic route was performed. The abdominal esophagus had been scarified circumferentially, and the esophagus was transected using a linear stapler on the proximal side of the anastomosis of the esophagojejunostomy at initial proximal gastrectomy.\u003c/p\u003e\n\u003cp\u003eAfter gastrectomy, the reconstructed jejunum was resected. At first, esophagojejunostomy was performed by an end-to-side anastomosis using a circular stapler (DST Series_ EEA_ Staplers, 25 mm, Covidien). Next, jejunojejunostomy was carried out by side-to-side anastomosis using an extracorporeal linear stapler. Total operation time was 3 hours, and total blood loss was 150 to 200 ml.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe have described a good result of a laparoscopic approach for total gastrectomy for gastric cancer following Roux-en-Y anastomosis. A literature review supports a minimally invasive approach for this procedure, showing that laparoscopic 3D view total gastrectomy is safer, more effective, and technically feasible.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cspan\u003eA statement on participant consent The protocol for this research project has been approved by The Second Affiliated Hospital of Harbin Medical University review Committee, which approved the investigation. The patients read this study\u0026apos;s protocol forms and signed written informed consent.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding acquisition:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo Conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical statement\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol for this research project has been approved by the Ethics Committee of the Second Affiliated Hospital of Harbin Medical University, which approved the investigation. Patients in this study signed written informed consent.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Soga R, et al. Completely laparoscopic extraperigastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach. Gastric Cancer. 1999;2(3):186-90.\u003c/li\u003e\n\u003cli\u003eKatai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer. 2010;13(4):238-44.\u003c/li\u003e\n\u003cli\u003eFujikawa H, Yoshikawa T, Aoyama T, Hayashi T, Cho H, Ogata T, et al. Laparoscopy-assisted distal gastrectomy for an early gastric cancer patient with situs inversus totalis. Int Surg. 2013;98(3):266-70.\u003c/li\u003e\n\u003cli\u003eMin SH, Lee CM, Jung HJ, Lee KG, Suh YS, Shin CI, et al. Laparoscopic distal gastrectomy in a patient with situs inversus totalis: a case report. J Gastric Cancer. 2013;13(4):266-72.\u003c/li\u003e\n\u003cli\u003eFonkalsrud EW, Tompkins R, Clatworthy HW, Jr. Abdominal manifestations of situs inversus in infants and children. Arch Surg. 1966;92(5):791-5.\u003c/li\u003e\n\u003cli\u003eMachado NO, Chopra P. Laparoscopic cholecystectomy in a patient with situs inversus totalis: feasibility and technical difficulties. Jsls. 2006;10(3):386-91.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":" gastric cancer, total gastrectomy, Roux-en-Y anastomosis ","lastPublishedDoi":"10.21203/rs.3.rs-6510402/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6510402/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe oncologic outcomes of laparoscopy-assisted gastrectomy for the treatment of gastric cancer have not been evaluated. This study aims to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer in terms of long-term survival. Laparoscopic gastrectomy has become widely used for the treatment of early gastric cancer in China; the feasibility of laparoscopic distal gastrectomy in particular has been assessed in several studies.[1, 2] However, laparoscopic procedures are more challenging in patients with previous abdominal surgery because of a higher risk of enteric injury, technical difficulties associated with adhesions, and longer operative times. In terms of the recent advantages of the laparoscopic technique, several reports have presented the usefulness of the laparoscopic approach for patients with remnant gastric cancer following radical distal gastrectomy.[3-6] Here, we present a case of laparoscopic total gastrectomy following Roux-en-Y anastomosis.\u003c/p\u003e","manuscriptTitle":"A Case of a very young female gastric cancer patient undergoing Laparoscopic total gastrectomy with Roux-en-Y anastomosis under a 3D camera.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 11:18:09","doi":"10.21203/rs.3.rs-6510402/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6570dc84-50ba-46fe-a9ce-967d96fe266d","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47749919,"name":"Gastrointestinal Surgery"}],"tags":[],"updatedAt":"2025-05-05T11:18:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 11:18:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6510402","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6510402","identity":"rs-6510402","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}