Laparoscopy-Assisted Distal Gastrectomy in a Patient With Situs Inversus Totalis

INTRODUCTION We report on a patient with situs inversus totalis who underwent laparoscopic-assisted distal gastrectomy (LADG) involving standard lymph node dissection (LND) for early gastric cancer. CASE DESCRIPTION A 42-y-old man presented at the Department of Internal Medicine in our hospital with the diagnosis of early gastric cancer detected elsewhere by upper endoscopy. Endoscopic submucosal dissection for this early gastric cancer was performed at our hospital. Histopathological examination of the resected specimen yielded the diagnosis of type 0-IIc, T1b1(SM), ly (+), v (-), UL (-), HM0, VM0, R0, according to the Japanese Classification of Gastric Carcinoma. Additional surgery was deemed necessary, and he was referred to our department. Preoperative computed tomography showed no liver or lung metastasis. The preoperative diagnosis was cStage IA (pT1b1, cN0, cH0, cP0, and cM0). Standard LADG with LND (D1 + No.7, 8a, 9) was performed successfully. Histological examination disclosed stage IB (pT1b1, pN1, sH0, sP0, and sM0). The patient was discharged on postoperative day 14 after an uneventful postoperative course. Eighteen months after the operation, he is doing well without recurrent gastric cancer. CONCLUSION Laparoscopic surgery for gastric cancer with SIT should be considered a feasible, safe, and curative procedure.