Resection for Local Recurrence after Total Gastrectomy to Gastric Cancer in Two Cases

Masahiro Suenaga, Hayato Sugiura, Yoshikazu Kokuba, Takashi Kurumiya, Hidetaka Yamanaka, Tsuyoshi Hatsuno

Surgical Survice, Nagoya Memorial Hospital

We report 2 patients who underwent total gastrectomy for gastric cancer, and then underwent resection for local recurrence. Case 1 (41-year-old woman): In the follow-up study after the first operation, upper gastrointestinal findings showed an irregular narrowing of the lifted jejunal loop, and computed tomography (CT) revealed a mass around the pancreatic tail. Invasion to celiac axis and common hepatic artery was not observed in celiac angiogram. We did not recognize obvious findings of peritoneal dissemination by using physical examination and imaging diagnosis. We underwent "en bloc" resection of multiple organs including the jejunum, part of the lateral segment of the liver, pancreatic body and tail, and transverese colon. Case 2 (58-year-old women): Barium enema showed an irregular narrowing of the splenic flexure of the colon 7 years after the first operation. Adenocarcinoma cells were proved by biopsy and CT and angiography indicated a mass in the pancreatic tail. There were no obvious findings of peritoneal dissemination. The tumor mass, the pancreatic body and tail, the ρ-loop of the jejunum, the transverse colon and the left adrenal gland were resected "en bloc". When local recurrence is found after total gastrectomy for gastric cancer, it is very difficult to determine whether or not peritoneal dissemination also coexist. However, it is recommended to make every effort to determine the extent of disease by using physical and imaging study, since operability depends upon such determinations.

Key words
gastric cancer, total gastrectomy, resection of local recurrence

Reprint requests
Masahiro Suenaga Surgical Survice, Nagoya Memorial Hospital
4-305 Hirabari, Tenpaku-ku, Nagoya, 468 JAPAN

Accepted
March 8, 1995

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