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Recorded for On-Demand Viewing
Recorded for On-Demand Viewing

Video Abstract

SSO Top Rated Video Abstracts

V1: Robotic-Assisted Proximal Gastrectomy with Double Tract Reconstruction​

Saturday, March 23, 2024
11:00am - 11:12am ET
Location: C101
Disclosure(s):
Jessica A. Steadman, MBBS: No financial relationships to disclose
Introduction: Total gastrectomy (TG) with D2 lymphadenectomy is the current standard surgical approach for resection of proximal gastric and gastroesophageal junction tumors with limited esophageal involvement. Minimally-invasive approaches have shown to offer equivalent oncologic outcomes but decreased morbidity and improved quality of life (QoL) over the open approach. However, TG can result in appetite loss due loss of ghrelin production with substantial weight loss, in addition to macrocytic anemia secondary to vitamin B12 deficiency, hinder long-term QoL. Evidence from Korea and Japan supports the role of proximal gastrectomy (PG) in offering a QoL benefit. Concern remains on whether PG enables adequate lymphadenectomy, though for early-stage tumors, oncologic equivalence between TG and PG has been demonstrated in Asia. PG is performed infrequently in the United States (US).


Methods: In this video, we present the case of a 67 year-old male with gastric adenocarcinoma of the cardia treated with neoadjuvant therapy followed by PG. The operative video outlines the steps of robotic-assisted PG with double tract reconstruction (DTR), highlighting key technical maneuvers to achieve a thorough modified D2 lymphadenectomy.


Results: The DTR is our preferred reconstructive method as it offers an anti-reflux mechanism. It does however necessitate an additional anastomosis, thus technical expertise with robotic gastrectomy is recommended prior to attempting this procedure. The barium contrast evaluation demonstrates patent EJ and GJ anastomoses and nicely depicts the DTR. 


Conclusions: Long-term data from the US on benefits relating to PG are lacking. Increasing awareness of PG and DTR will promote greater collaboration among US surgeons with the hope of answering the question as to whether PG offers a QoL benefit in Western populations. 

Learning Objectives:

  • describe the key steps to performing robotic proximal gastrectomy with double tract reconstruction.
  • list the recommended lymph node basins dissected as part of proximal gastrectomy performed for gastric adenocarcinoma.
  • implement training practices to begin performing robotic assisted proximal gastrectomy.