Laparoscopic Radical Gastrectomy for Remnant Gastric Cancer

The research outlines a practical operating procedure to guide surgeons and encourage wider adoption of laparoscopic surgery for remnant gastric cancer management. The current experimental challenges include demanding anatomical orientation and advanced laparoscopic skill to manage adhesions near the anastomosis, jejunal mesentery, and splenic hilum. To begin, conduct a thorough assessment of adhesions within the abdominal cavity and evaluate the presence of tumor implantation and infiltration of adjacent organs.

To avoid injury to the jejunal limb, pancreatic tail, mesocolon and portal vein trunk, perform adhesiolysis using a combination of blunt and sharp dissection. Tailor lymph adenectomy for remnant gastric cancer according to the prior surgical approach, tumor location, and initial reconstruction method. Follow the standard D2 plus radical surgery guidelines with special attention to ectopic nodes around the celiac axis, splenic hilum, and jejunal mesentery.

Mobilize the cardia and at least six centimeters of the distal esophagus using an ultrasonic scalpel to ensure a safe and tension-free anastomosis, especially for tumors involving the cardia or distal esophagus. For cases with previous distal gastrectomy and Billroth II reconstruction, transect the jejunal input and output loops at the prior gastrojejunostomy with a linear stapler. When the tumor does not involve the cardia, perform a side-to-side esophagojejunostomy using a linear stapler before transecting the lower esophagus to prevent retraction into the thoracic cavity after transection.

Perform a side-to-side jejunojejunostomy at the distal jejunum located 45 centimeters from the esophagal duodenal anastomosis. Place the resected specimen in a sterile retrieval bag. Then irrigate the surgical field with sterile distilled water to ensure hemostasis and confirm the absence of gastric leakage.

Place one or two drainage tubes near the left sub phrenic space and around the jejunal anastomosis to facilitate postoperative monitoring. All five male patients had previously undergone open distal gastrectomy with Billroth II reconstruction for benign disease with a median time interval of 480 months between initial surgery and remnant gastric cancer diagnosis. The median body mass index was 22.1 kilograms per square meter.

Preoperative laboratory values showed a median white blood cell count of 7.16 times 10 to the power of 9 per liter, a median hemoglobin level of 10 to the power of 5 grams per liter, and a median platelet count of 230 times 10 to the power of 9 per liter. The median carcino embryonic antigen level was 1.64 nanograms per milliliter. All patients underwent laparoscopic radical gastrectomy without conversion to open surgery with a median operation time of 380 minutes and a median intraoperative blood loss of 100 milliliters.

One patient developed a postoperative pulmonary infection, while no other postoperative complications were observed. Pathologic T classification was T3 in three patients and T4 in two patients. Lymph node classification showed N0 in two patients, N1 in one patient, and N3 in two patients.

All five patients were classified as M0, indicating no distant metastasis. Tumor differentiation was moderate in three cases and poor in two cases. This study aims to systematically introduce the experiences of laparoscopic radical gastrectomy for remnant gastric cancer and provide supplementary information for the existing research data.

The findings aim to support broader use of laparoscopic radical gastrectomy as remnant gastric cancer cases rise, emphasizing expert surgeons, sound judgment, and high volume specialized centers. Future research will focus on larger clinical studies to validate outcomes and strengthen evidence beyond this technical demonstration.