A 79-year-old male was admitted to our hospital for the treatment of cancer of the gastric tube.Gastrointestinal examination revealed a T1 b Union for International Cancer Control(UICC) tumor at the pyloric region of ...A 79-year-old male was admitted to our hospital for the treatment of cancer of the gastric tube.Gastrointestinal examination revealed a T1 b Union for International Cancer Control(UICC) tumor at the pyloric region of the gastric tube.Laparotomy did not reveal infiltration intothe 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,pT 1bN 0M0,pS tage 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.展开更多
A 47-year-old woman presented to our hospital with complaints of dysphagia. Esophagogastroduodenoscopy identified a submucosal tumor in the left wall of the esophagus that was diagnosed as a benign schwannoma on biops...A 47-year-old woman presented to our hospital with complaints of dysphagia. Esophagogastroduodenoscopy identified a submucosal tumor in the left wall of the esophagus that was diagnosed as a benign schwannoma on biopsy. Computed tomography revealed a tumor of length 60 mm in the thoracic esophagus, with its cranial edge at the level of the aortic arch. On endoscopy, a submucosal tunnel was created 40 mm proximal to the cranial edge of the tumor, and its oral end was dissected from the mucosal and muscular layers. This was followed by the resection of the entire tumor by left-sided thoracoscopy. The esophageal defect was closed in layer by continuous suture from the thoracic side. Endoscopic closure was achieved by using clips. No postoperative complications were observed. Oral diet was resumed from postoperative day 7 and the patient was discharged on postoperative day 9. This combined approach has not been described for similar tumors. Our experience demonstrated that large esophageal tumors can be safely excised with minimally invasive surgery by using a combination of thoracoscopy and endoscopy.展开更多
文摘A 79-year-old male was admitted to our hospital for the treatment of cancer of the gastric tube.Gastrointestinal examination revealed a T1 b Union for International Cancer Control(UICC) tumor at the pyloric region of the gastric tube.Laparotomy did not reveal infiltration intothe 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,pT 1bN 0M0,pS tage 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.
文摘A 47-year-old woman presented to our hospital with complaints of dysphagia. Esophagogastroduodenoscopy identified a submucosal tumor in the left wall of the esophagus that was diagnosed as a benign schwannoma on biopsy. Computed tomography revealed a tumor of length 60 mm in the thoracic esophagus, with its cranial edge at the level of the aortic arch. On endoscopy, a submucosal tunnel was created 40 mm proximal to the cranial edge of the tumor, and its oral end was dissected from the mucosal and muscular layers. This was followed by the resection of the entire tumor by left-sided thoracoscopy. The esophageal defect was closed in layer by continuous suture from the thoracic side. Endoscopic closure was achieved by using clips. No postoperative complications were observed. Oral diet was resumed from postoperative day 7 and the patient was discharged on postoperative day 9. This combined approach has not been described for similar tumors. Our experience demonstrated that large esophageal tumors can be safely excised with minimally invasive surgery by using a combination of thoracoscopy and endoscopy.
