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Single-Stage Laparoscopic Endoscopic Cooperative Surgery for Gastric Submucosal Tumor and Laparoscopic Distal Gastrectomy for Early Gastric Cancer: A Case Report

Hisahito Endo, Zenichiro Saze, Takuto Hikichi, Akinao Kaneta, Masayuki Watanabe, Tomohiro Kikuchi, Junichiro Watanabe, Takeshi Tada, Hiroyuki Hanayama, Tetsu Sato, Fumihiko Osuka, Jun Nakamura, Ko Watanabe, Hitomi Kikuchi, Yuichi Waragai, Yuko Hashimoto, Hiromasa Ohira, Mitsukazu Gotoh

(Department of Regenerative Surgery, Fukushima Medical University, Fukushima, Japan)

Med Sci Case Rep 2016; 3:58-63

DOI: 10.12659/MSCR.899928


BACKGROUND: Laparoscopic and endoscopic cooperative surgery (LECS) has increasingly been used for gastric submucosal tumors (SMTs) to avoid excessive resection of the gastric wall, and laparoscopic gastrectomy has been almost routinely applied for gastric cancer. However, there has been no report of a combined procedure for a single patient. Here, we report on a case of simultaneous single-stage LECS for a U-portion gastric SMT and laparoscopic distal gastrectomy (LDG) for an M-portion early gastric cancer.
CASE REPORT: A 40-year-old woman was found to have a 7-mm SMT on the posterior gastric wall just below the esophagogastric junction, as well as a 10-mm type 0-IIc lesion in the stomach M-portion. Pathological examination for the 0-IIc lesion indicated signet-ring cell carcinoma, and the clinical diagnosis was cT1aN0M0; c-stage IA. The SMT was so small that it could be followed without resection, but if it were to grow, it would require open total gastrectomy leading to a nutritionally deprived state compared to having a gastric remnant. Thus, a single-stage operation comprising LECS for the SMT and LDG for the gastric cancer was planned and performed. The operating time was 8 h 15 min, and blood loss was 1 g. The definitive diagnosis of the SMT was leiomyoma. The patient’s postoperative course was uneventful, and she was discharged on postoperative day 7 and has a very active daily life with good nutrition.
CONCLUSIONS: LECS and LDG were successfully performed at the same time for 2 lesions of the stomach.

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