7. Multivisceral resection for advanced gastric cancer: Distal subtotal gastrectomy with pancreatoduodenectomy (D3 aortocaval lymphatic dissection)

Abstract

S S13 Conclusions: RAMPS with multivisceral resection and extended lymphatic dissection can be safely pursued in patients with locally advanced pancreatic cancer to achieve an R0 resection. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.004 7. Multivisceral resection for advanced gastric cancer: Distal subtotal gastrectomy with pancreatoduodenectomy (D3 aortocaval lymphatic dissection) I. Shchepotin, A. Lukashenko, O. Kolesnik, V. Prymak 1 National Cancer Institute, Abdominal Oncology, Kyiv, Ukraine Background: Surgical management remains the cornerstone of multidisciplinary treatment in advanced gastric cancer, as the complete R0 resection confers only chance for cure of the disease. Over the past decades the operative technique and perioperative management have been noticeably advanced, which lead to the improved survival as well as the lower morbidity and mortality in high-volume specialized centers. Materials andmethods:Wepresent a patientwith aT4gastric tumorwho underwent anopenmultivisceral enbloc resection (distal gastrectomyandpancreatoduodenectomy) and extended aortocaval D3 lymphadenectomy. Results: The case of a 51-year-old man suffering from advanced low third gastric cancer is presented to illustrate the technique. Disease-free margins of resection were achieved. Pathology revealed a poorly differentiated gastric adenocarcinoma involving the stomach and pancreas. There was now incidence of pancreatic fistula and delay gastric emptying in early postoperative period, with a total hospital stay of 10 days. Seven months after surgery, she has no recurrence or distal metastasis. Conclusions: Distal subtotal gastrectomy with multivisceral resection pancreatoduodenectomy and extended D3 lymphatic dissection can be safely pursued in patients with locally advanced gastric cancer to achieve an R0 resection. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.005 8. Multivisceral resection for advanced gastric cancer: Total gastrectomy with radical antegrade modular pancreatosplenectomy (D3 lymphatic dissection) I. Shchepotin, A. Lukashenko, O. Kolesnik, V. Prymak 1 National Cancer Institute, Abdominal Oncology, Kyiv, Ukraine Background: Gastric cancers are the second most common cause of cancer death worldwide. In the majority of countries, gastric tumors are diagnosed at advanced stages. The overall prognosis and survival of patients with advanced gastric cancer is generally poor. One of the most powerful predictors of outcomes in gastric cancer surgery is an R0 resection. However, the extent of the required lymphatic dissection during surgical resection for advanced gastric cancer are controversial. Materials and methods: The author present case of a patient with a T4 gastric tumour who underwent an open multivisceral en bloc resection (total gastrectomy and partial pancreatectomy) and extended aortocaval D3 lymphadenectomy. The pancreatic dissection was performed in the manner of radical antegrade modular pancreatosplenectomy (RAMPS) technique which used for distal pancreatic cancer. Results: Multivisceral surgical resection for cure was successfully performed in a 69-year-old woman suffering from a gastric cancer associated with direct invasion to the pancreatic body and splenic vessels. The patient presented with gastric outlet obstruction, upper abdominal pain. The patient’s postoperative course was uneventful. Nine months after surgery, she has no recurrence or distal metastasis. Conclusions: Total Gastrectomy with multivisceral resection e RAMPS with extended D3 lymphatic dissection can be safely pursued in patients with locally advanced gastric cancer to achieve an R0 resection. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.006 9. Thoracic vascular injuries during oesophageal resection in the prone position J.M. Del Pino Monzon, V. Concepcion Martin, J.G. Diaz Mejias, B. Reyes Correa, M. Alonso Gonzalez, E. Moneva Arce, A. Soriano Benitez de Lugo 1 Hospital Universitario Ntra. Sra. de Candelaria, Surgery, Santa Cruz de Tenerife, Spain Background: The introduction of video assisted oesophageal cancer resections techniques has decreased morbidity of this complex surgery with similar oncologic results. But intraoperative complications appear similar to classic thoracotomy with the inconvenience of limited access of a minimally invasive approach. This is highly relevant facing a vascular injury. Material and methods: After initial experience with minimally invasive transhiatal oesophagectomy experience (2004e2007) we changed to videoassisted thoracic oesophageal approach in the left lateral decubitus (2007e2008) and then in August 2008 we moved to a totally thoracoscopic approach in the prone position. Since then we managed 19 oesophageal cancer patients with a totally thoracolaparoscopic McKeown technique. Results: We herein present a video record of some vascular injuries during the thoracoscopic resection of oesophagus in the prone position and its management. Two patients bleed from a direct aortic oesophageal artery and could be managed with direct compression and bipolar electrocoagulation. An injury of Inferior Lobal Pulmonary vein had to be controlled with clips. Left Pulmonary Vein injury needed thoracoscopic hand sewn and one patient had an Aberrant Subclavian Artery (Arteria Lusoria) mistaken as oesophagus and finally respected. Conclusions: Thoracoscopic oesophageal surgery in the prone position is a feasible technique but it isn’t free of vascular injuries risks and the surgeon must be aware of them. Advanced thoracolaparoscopic surgical skills including hand sewing must be needed to solve fastly and safely these potentially lethal events. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.007