Robotic subtotal resection of remnant stomach with Roux-en-Y gastrojejunostomy combined with fluorescent lymphography-guided lymphadenectomy for remnant gastric cancer

Remnant gastric cancer (RGC) poses unique surgical challenges due to prior surgical alterations and associated fibrosis. Although completion total gastrectomy is traditionally performed for RGC, subtotal resection of the remnant stomach has emerged as a viable alternative. We developed a novel approach that combines robotic subtotal resection of the remnant stomach with Roux-en-Y gastrojejunostomy and indocyanine green (ICG) fluorescent lymphography-guided lymphadenectomy to treat RGC. Preoperative endoscopic ICG injection was performed the day before surgery to guide intraoperative fluorescent lymphography-guided lymphadenectomy. This surgical technique report from a single center details the surgical steps and includes an accompanying video. The mean patient age was 59.5 years, and the mean operative time was 260.3 min. All patients successfully underwent robotic subtotal resection of the remnant stomach, without conversion to open surgery. ICG fluorescent lymphography-guided lymphadenectomy aided in accurate lymph node dissection, and all patients had negative resection margins. No grade III or higher complications were observed in this study. The mean postoperative hospital stay was 6.7 days, and no recurrence occurred during the mean follow-up period of 15.8 months. Robotic subtotal resection of the remnant stomach with ICG fluorescent lymphography-guided lymphadenectomy is a feasible and safe option for the treatment of RGC. This approach enables organ preservation and may contribute to maintaining postoperative function, making it a promising alternative to completion total gastrectomy for selected patients with RGC. It enables precise lymphadenectomy and secures resection margins, making it a promising alternative to completion total gastrectomy for selected patients with RGC.