Robotic-Assisted Total Gastrectomy for Gastric Cancer After Coronary Artery Bypass Grafting Using the Right Gastroepiploic Artery: A Case Report

TL;DR

A patient with gastric cancer who had a prior heart surgery using the right gastroepiploic artery underwent robotic stomach removal while preserving the artery.

Contribution

Demonstrates robotic surgery's potential to safely preserve a coronary graft during gastric cancer surgery.

Findings

Robotic total gastrectomy preserved the right gastroepiploic artery graft used in prior CABG.

Infra-pyloric lymph node dissection was avoided due to the graft's presence.

Robotic surgery may offer precision to avoid damaging prior grafts during gastrectomy.

Abstract

The right gastroepiploic artery (RGEA) is frequently used in coronary artery bypass grafting (CABG) for right coronary artery bypass requiring long-term patency. We experienced a case of upper-third advanced gastric cancer after CABG using RGEA. The absence of enlarged lymph nodes (LNs) or distant metastasis was confirmed through computed tomography (CT), and the RGEA graft remained patent according to coronary CT angiography. Based on these findings, the patient underwent robotic total gastrectomy while preserving the RGEA graft without infra-pyloric LN dissection. We suggested that caution should be exercised to avoid injury to the graft during gastrectomy, and robotic surgery could contribute to safely preserving the RGEA. We should consider the decision to dissect the infra-pyloric LN for the patient's safety and curability.

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