Modified stomach-partitioning gastrojejunostomy for initially unresectable advanced gastric cancer with outlet obstruction: A case report

Figure 1 Clinical data of the patient at the initial diagnosis. A-C: Normal endoscopic showing primary tumor invasion to the antrum (A), pyloric ring (B), and duodenum (C); D: Pathological examination of the endoscopic biopsy revealed a poorly differentiated adenocarcinoma; E-H: Initial computed tomography showing primary tumor invasion to the duodenum (E) and lymph node metastases (F-H).

Figure 2 Stomach-partitioning gastrojejunostomy and Braun anastomosis combined with No. 4sb lymph node dissection. A: Intraoperative laparoscopic images; B: Illustration of the modified stomach-partitioning gastrojejunostomy.

Figure 3 Clinical data of the patient after operation and conversion therapy. A: Upper digestive tract radiography showed a good passage to the jejunum; B: Endoscopic showing good drainage route in the lesser curvature; C: Endoscopic evidence of good reduction of primary tumor.

Figure 4 Computed tomography findings after conversion therapy. A: Primary tumor reduction; B-D: Metastatic lymph node reduction.

Figure 5 Subtotal gastrectomy with D2 lymph node dissection. A: Intraoperative laparoscopic images; B: Illustration of the gastrectomy, the anastomoses completed in the previous operation were preserved.

Figure 6 Post-operative pathology showed no residual tumor cells, and a pathological complete response was achieved. A: Hematoxylin and eosin staining results, × 4; B: Hematoxylin and eosin staining results, × 40.