Laparoscopy-assisted gastrectomy with para-aortic lymphadenectomy after palliative chemotherapy for advanced gastric cancer with isolated para-aortic lymph node metastasis
A 45 year-old man was diagnosed with a poorly differentiated adenocarcinoma in the gastric angle by gastroscopy. A positron emission tomography-computed tomography (PET-CT) suggested left para-aortic and aortocaval lymph node metastasis. After completing 4 cycles of XELOX, the patient showed partial response to the chemotherapy with decreased extent of primary cancer and retroperitoneal lymph nodes. After the confirmation of no evidence of seeding in the diagnostic laparoscopy, he underwent a successful laparoscopic extended total gastrectomy with para-aortic lymphadenectomy with the usual 5-port system without additional port insertion. The total operative time was 370 minutes and para-aortic lymphadenectomy took 100 minutes. The estimated blood loss (EBL) was 125 mL. The pathologic results revealed no residual primary tumor and no lymph node metastasis in harvested 77 lymph nodes (LNs; 16a2 [0/3], 16b1 [0/5]). He recovered and was discharged at postoperative 8 days without any complications.