A Distal Gastrectomy of Early Stomach Cancer in a Patient Who Had Previously Undergone Hassab's Operation, an Esophageal Transection and Endoscopic Injection Therapy

Hidefumi Baba, Katsunori Tanaka, Shigenao Kan, Fumio Suzuki, Hitoshi Otaka, Takao Moriya, Hitoshi Ito*, Masahiko Takao*

Department of Surgery, Tachikawa Kyosai Hospital
*Department of Internal Medicine, Tachikawa Kyosai Hospital

This case report describes the use of distal gastrectomy to treat early stomach cancer in a patient who had previously undergone Hassab's operation, a transabdominal esophageal treansection and endoscopic injection therapy. A 63-year-old man, who had previously undergone Hassab's operation with transabdominal esophageal transection for gastric varices in 1987, and endoscopic injection therapy (EIS) for esophageal varices in 1995, was admitted to our hospital because early gastric cancer in the antrum had been incidentally detected by endoscopy during a follow-up examination in 1997. Preoperative angiogaphy revealed that the blood supply to the lesser and greater curvature of the stomach was through the right gastric and gastroepiploic arteries, respectively. Therefore, although the tumor was located in the antrum, the indicated procedure in this case of gastric cancer was a total gastrectomy with a Roux-en-Y anastomosis. However, since the patient had a past history of esophageal transection and EIS, a total gastrectomy was ruled out because of the increased risk of anastomotic leakage. The procedure of choice was thus changed to a distal gastrectomy. We determined that the color of the serosal surface of the remaining stomach did not change after dividing the right gastric and gastroepiploic arteries, indicating that the blood supply was sufficient to perform an anastomosis between the remaining stomach and jejunum. Therefore, a distal gastrectomy was performed, and the patient successfully recovered without complications related to the operation.

Key words
gastric cancer with esophagogastric varices, Hassab's operation, distal gastrectomy

Reprint requests
Hidefumi Baba Tachikawa Kyosal Hospital
4-2-22 Nishiki-cho, Tachikawa, Tokyo, 190-8531 JAPAN

Accepted
March 11, 1998

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