Abstract
A 73-year-old man diagnosed with gastric cancer underwent laparoscopic total gastrectomy at our hospital 12 months ago. The histopathological diagnosis was a poorly-differentiated adenocarcinoma limited to the gastric submucosa, pT1b (SM2) , pN0, stage IA. Computed tomography (CT) performed at the outpatient follow-up 6 months after surgery revealed a pancreatic body. No other definite mass shadow was detected. Positron emission tomography (PET) -CT revealed high accumulation (SUVmax) near the site of the pancreatic body. We performed laparoscope-assisted distal pancreatectomy to remove the tumor which had gradually increased over the intervening 6 months. The histopathlogical diagnosis was a poorly-differntiated adenocarcinoma resulting from lymph node metastasis of the gastric cancer. In general, skip metastasis is due to the presence of a metastatic lymph node in an extraperigastric area without perigastric involvement. The mechanism and prognosis are still unknown. The frequency of skip metastasis along the proximal splenic artery is rare. Since adhesions after previous laparoscopic surgery were mild, it was possible to perform laparoscopic surgery once again, taking advantage of its benefits, both during surgery and in the post-operative healing period.
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