Surgical case reports · 2026
Indocyanine Green Fluorescence-Guided Laparoscopic Subtotal Gastrectomy for Remnant Gastric Cancer after Pancreaticoduodenectomy: A Case Report.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Inamoto Osamu, Sakamoto Shuhei, Fujimoto Takashi, Nishiyama Kazuhiro, Ogawa Ryotaro, Yoshizawa Atsushi, Taki Yoshiro, Komoto Izumi
Аннотация
INTRODUCTION: Remnant gastric cancer (RGC) is rare after pancreaticoduodenectomy (PD). Surgical management of such cases is technically challenging because of postoperative adhesions and altered anatomy due to reconstruction. Although a completion total gastrectomy is the standard treatment for RGC, it can be highly invasive, particularly in elderly patients with significant comorbidities. While function-preserving subtotal gastrectomy or minimally invasive approaches have been considered, they remain technically demanding. Recent advances in indocyanine green (ICG) fluorescence imaging have facilitated precise tumor localization and real-time tissue perfusion assessment in complex surgical settings.
CASE PRESENTATION: A 75-year-old man with a 24-year survival history after PD for pancreatic cancer presented with early-stage RGC (0-IIa, size 35 mm, invading the submucosa). The patient was at high risk, with a history of cerebral infarction requiring dual antiplatelet therapy and long-term corticosteroid therapy for pemphigus vulgaris. A laparoscopic subtotal gastrectomy was performed. Preoperative endoscopic ICG fluorescent clipping guided the determination of an adequate surgical margin under near-infrared visualization, despite dense adhesions. ICG fluorescence enabled precise tumor localization and confirmation of adequate perfusion, thereby facilitating stomach-preserving resection. Although the postoperative course was complicated by a Grade B pancreatic fistula that was managed conservatively, the patient was discharged.
CONCLUSIONS: Laparoscopic subtotal gastrectomy with ICG fluorescence guidance can be considered a technically useful surgical option for RGC, even 24 years after PD. This technique provides precise tumor localization and real-time perfusion assessment, assisting surgical resection in high-risk patients with multiple comorbidities and complex reoperative anatomy.
CASE PRESENTATION: A 75-year-old man with a 24-year survival history after PD for pancreatic cancer presented with early-stage RGC (0-IIa, size 35 mm, invading the submucosa). The patient was at high risk, with a history of cerebral infarction requiring dual antiplatelet therapy and long-term corticosteroid therapy for pemphigus vulgaris. A laparoscopic subtotal gastrectomy was performed. Preoperative endoscopic ICG fluorescent clipping guided the determination of an adequate surgical margin under near-infrared visualization, despite dense adhesions. ICG fluorescence enabled precise tumor localization and confirmation of adequate perfusion, thereby facilitating stomach-preserving resection. Although the postoperative course was complicated by a Grade B pancreatic fistula that was managed conservatively, the patient was discharged.
CONCLUSIONS: Laparoscopic subtotal gastrectomy with ICG fluorescence guidance can be considered a technically useful surgical option for RGC, even 24 years after PD. This technique provides precise tumor localization and real-time perfusion assessment, assisting surgical resection in high-risk patients with multiple comorbidities and complex reoperative anatomy.