Laparoscopy-assisted gastrectomy with para-aortic lymphadenectomy after palliative chemotherapy for advanced gastric cancer with isolated para-aortic lymph node metastasis
A 46 year-old woman was diagnosed with a poorly differentiated adenocarcinoma in the gastric body, and CT suggested bulky perigastric lymph nodes (station 3 and 7, 2.0 cm and 1.0 cm) and left PAN metastasis (2.2 cm). After completing 4 cycles of XP, she showed partial response to the chemotherapy with decreased sizes of perigastric (0.9 cm and 0.6 cm) and left PANs (0.8 cm). She underwent laparoscopic subtotal gastrectomy with para-aortic lymphadenectomy, but the small branch of the left renal vein was injured at the end of para-aortic lymphadenectomy, so bleeding control was performed via minilaparotomy. The total operative time was 415 minutes and para-aortic lymphadenectomy took 97 minutes. The EBL was 200 mL. The pathologic results revealed submucosa tumor and 6 LNs metastases in 58 harvested LNs (16a2 [0/0], 16b1 [0/11]). She was discharged at 11 days postoperatively after conservative management due to a large amount of ascites.