Laparoscopic and endoscopic cooperative surgery for advanced gastric cancer as palliative surgery in elderly patients: a case report

Marie Washio, Naoki Hiki, Kei Hosoda, Masahiro Niihara, Motohiro Chuman, Mikiko Sakuraya, Takuya Wada, Hiroki Harada, Takeo Sato, Kiyoshi Tanaka, Takeshi Naitoh, Yusuke Kumamoto, Takafumi Sangai, Satoshi Tanabe, Keishi Yamashita, Marie Washio, Naoki Hiki, Kei Hosoda, Masahiro Niihara, Motohiro Chuman, Mikiko Sakuraya, Takuya Wada, Hiroki Harada, Takeo Sato, Kiyoshi Tanaka, Takeshi Naitoh, Yusuke Kumamoto, Takafumi Sangai, Satoshi Tanabe, Keishi Yamashita

Abstract

Background: The number of elderly patients with gastric cancer is increasing, with the very elderly often refusing radical gastrectomy with lymph node dissection. Such a patient presented to us and we proposed a palliative surgery involving gastric local resection using laparoscopy endoscopy cooperative surgery (LECS).

Case presentation: An 89-year-old woman presented to our hospital with progressing anemia. She had an aortic arch replacement for aortic dissection 6 months previously and was taking antithrombotic drugs for atrial fibrillation. She was diagnosed with advanced gastric cancer, and we presented a radical resection treatment plan involving distal gastrectomy with lymph node dissection. However, she strongly refused undergoing radical gastric cancer resection. We believed that at least local control of the tumor could be effective in preventing future bleeding or stenosis due to tumor progression. Therefore, we proposed a local gastrectomy with LECS as an optional treatment, and she agreed to this treatment. The surgery was performed with minimal blood loss, and no postoperative complications were observed. Histopathological examination revealed a 45 × 31-mm, Type 2, poorly differentiated adenocarcinoma (pT4a, ly0, v1a), and the resected margin was negative. The patient was alive 2 years after surgery without apparent recurrence or other illness. In addition, her weight was maintained, together with her daily activity.

Conclusion: Local resection of gastric cancer with LECS might be an option for the palliative treatment of patients who refuse radical resection of gastric cancer.

Keywords: Elderly; Gastric cancer; Laparoscopic and endoscopic cooperative surgery; Palliative surgery.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Gastroscopy revealed a Type 2 advanced gastric cancer at the posterior wall of the stomach
Fig. 2
Fig. 2
Intraoperative endoscopy for confirmation showed almost no deformation of the stomach
Fig. 3
Fig. 3
Postoperative pathologic examination demonstrated the following: 45 × 31-mm, Type 2, poorly differentiated adenocarcinoma (pT4a, ly0, v1a), with no lymph node metastases (0/6)
Fig. 4
Fig. 4
Postoperative upper gastrointestinal fluoroscopy showed little gastric deformity, good peristalsis, and the smooth flow of contrast agent into the duodenum

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