# A Case of Ascending Colon Cancer Resected by Laparoscopic Right Hemicolectomy with Intracorporeal Anastomosis after Total Gastrectomy: A Case Report

## TL;DR

A patient with a history of total gastrectomy successfully underwent laparoscopic right hemicolectomy with intracorporeal anastomosis for ascending colon cancer.

## Contribution

This case report presents a novel surgical approach using intracorporeal anastomosis in patients with prior total gastrectomy.

## Key findings

- Intracorporeal anastomosis allowed surgery without adhesion release in a patient with prior gastrectomy.
- The patient had an uneventful recovery and was discharged within 8 days.
- This approach minimized mobilization and preserved the reconstructed jejunum.

## Abstract

There are few reports of treatment strategies for ascending colon cancer after total gastrectomy. We report a case of intracorporeal anastomosis was performed for ascending colon cancer after total gastrectomy with Roux-en-Y reconstruction.

A 70-year-old man was referred to our institution due to a primary complaint of blood stool. A colonoscopy showed a Type 2 tumor near the hepatic fold of the ascending colon. The clinical diagnosis was ascending colon cancer. He had a history of open total gastrectomy (Roux-en-Y, retrocolic route) and cholecystectomy for gastric cancer in his 40s. Laparoscopic right hemicolectomy with intracorporeal anastomosis was performed. To perform an extracorporeal anastomosis, it was necessary to release adhesions between the reconstructed jejunum and the left-sided transverse colon and mobilize the splenic flexure. If the reconstructed jejunum was damaged, there will be a possibility of redoing the esophago-jejunostomy. By performing an intracorporeal anastomosis, surgery was accomplished with minimal mobilization and without requiring adhesion release between the reconstructed jejunum and the transverse colon. The patient’s postoperative course was uneventful, and he was discharged at 8 days postoperatively.

Intracorporeal anastomosis may represent a useful and safe option when performing laparoscopic right colectomy in patients with a history of total gastrectomy.