Radical proximal gastrectomy with modified double tracks anastomosis after preoperative chemotherapy for gastric cancer

A 65-year-old female patient with advanced gastric cancer received post-chemotherapy surgery. Gastroscopy showed a cauliflower-like mass was present at the lesser curvature of the gastric cardia, with its surface being damaged. An ulcer-like lesion was located from the lesser curvature of the lower cardia to the lesser curvature of the middle portion of the gastric body. The lesion was fragile and easy to bleed. Abdominal CT showed thickened walls of cardia, which was consistent with the diagnosis of “carcinoma of the gastric cardia”. The TNM stage was considered to be T4aN2M0. He received chemotherapy before surgery. The cancer was down-staged after chemotherapy. The response evaluation was categorized as partial response (PR) according to RECIST criteria. Radical proximal gastrectomy with modified double tracks anastomosis were performed three weeks later. The intra-operative blood loss was little. Mild edema and adhesion of the local tissue were observed, but did not affect the surgical operation or prolong the surgical duration. No significantly enlarged lymph node was detected during intra-operative exploration. A limited number of small lymph nodes were dissected. The anastomotic tension was low, and the blood supply was good. Mild hypoproteinemia was detected after surgery and successfully corrected. No other complication occurred. The post-operative recovery was smooth. The postoperative pathology was ypT2N0M0 IB, and the tumor regression grade (TRG) was TRG 1.