Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4314-4320
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4314
Natural orifice specimen extraction with laparoscopic radical gastrectomy for distal gastric cancer: A case report
Peng Sun, Xi-Shan Wang, Qi Liu, Yu-Song Luan, Yan-Tao Tian
Peng Sun, Xi-Shan Wang, Qi Liu, Yu-Song Luan, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Peng Sun, Xi-Shan Wang, Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, China
Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Tian YT and Wang XS designed the report; Sun P, Liu Q, and Luan YS collected the patient’s clinical data; Sun P analyzed the data and wrote the paper. Sun P and Wang XS contribute equally to this article.
Supported by National Natural Science Foundation of China, No. 81772642. Beijing science and technology plan, No.D171100002617004.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yan-Tao Tian, MD, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tyt67@163.com
Telephone: +86-10-87787120 Fax: +86-10-87787120
Received: September 15, 2019
Peer-review started: September 15, 2019
First decision: October 14, 2019
Revised: November 11, 2019
Accepted: November 20, 2019
Article in press: November 20, 2019
Published online: December 26, 2019
Processing time: 100 Days and 21 Hours
Abstract
BACKGROUND

This article introduces the surgical method and early experience in performing totally laparoscopic radical gastrectomy with transrectal specimen extraction for gastric cancer, and we evaluate the short-term effects and feasibility of this new procedure for gastric cancer in a 64-year-old male patient. This approach may provide new possibilities for gastric natural orifice specimen extraction (NOSE) surgery. In addition, we believe that this new procedure may further relieve pain, speed up recovery, and cause minimal physiological and psychological impact.

CASE SUMMARY

We performed NOSE gastrectomy in a male patient. Tumor resection, digestive tract reconstruction, and lymph node dissection were performed totally laparoscopically; the specimen was extracted from the natural orifice of the rectum-anus. This procedure reduced damage to the abdominal wall and decreased postoperative pain. We successfully performed radical gastrectomy without conversion and complications. Total operative time and blood loss were 176 min and 50 mL, respectively. The patient resumed normal activities of daily living on day 1 without pain, and passed flatus within 48 h. Postoperative hospital stay was 10 d. The number of resected lymph nodes was 0/43. During the follow-up, no stricture or anastomotic leakage was detected. Three months postoperatively, colonoscopy showed full recovery of the rectum without stricture or scar contracture. Computed tomography and laboratory test results showed no signs of tumor recurrence. There was no visible scar on the abdominal wall.

CONCLUSION

It is safe and reliable to perform totally laparoscopic radical gastrectomy with transrectal specimen extraction for distal gastric cancer patients.

Keywords: Gastric cancer; Totally laparoscopic surgery; Transrectal; Natural orifice specimen extraction; Postoperative pain; No visible incision; Case report

Core tip: We successfully performed transrectal specimen extraction gastrectomy in a male patient without conversion and complications. This procedure significantly reduced damage to the abdominal wall and decreased postoperative pain. There was no visible scar on the abdominal wall. Total operative time and blood loss were 176 min and 50 mL, respectively. The patient resumed normal activities on day 1 without pain, and passed flatus within 48 h. Postoperative hospital stay was 10 d. The number of resected lymph nodes was 0/43. During the follow-up, no complications were detected, and computed tomography and laboratory test results showed no signs of tumor recurrence.