[A Case of Laparoscopic Total Gastrectomy and Enterostomy with R Anastomosis for Advanced Gastric Cancer in an Older Patient].

An 85-year-old female underwent an upper gastrointestinal endoscopy revealed a type 4 tumor extending from the lesser curvature to the antecubital area, and stenosis of the pyloric lesion. Histology of the biopsy sample showed adenocarcinoma (tub2). CT revealed thickening of the stomach wall and numerous enlarged lymph nodes. Laparoscopic total gastrectomy, D2 dissection, Roux-en-Y reconstruction, and enterostomy were performed. After resection, the jejunum was removed from the abdominal cavity and transected 25 cm from the ligament of Treitz. An R anastomosis was created 10 cm from the anal side to the esophagojejunostomy anastomosis, and an enterocutaneous fistula tube was inserted from the blind end 10 cm from the R anastomosis. Laparoscopic esophagojejunostomy was performed using the overlap method. The enterocutaneous fistula was guided laparoscopically from the left costal region. Postoperatively, the patient was maintained on a diet with nutritional management via an enterostomy. No postoperative or enterostomy-related complications were observed. The postoperative course was uneventful and the patient was discharged from the hospital on the postoperative day 22. There was no deterioration in the nutritional status after discharge. Pathology results showed Stage Ⅳ, pT4aN3bM1. The patient did not receive chemotherapy per her request.