[A Case of Laparoscopic Splenectomy after Distal Gastrectomy for Gastric Cancer]

We report a case of laparoscopic splenectomy after distal gastrectomy for gastric cancer. A 68-year-old woman underwent laparoscopic distal gastrectomy, D1+lymph node dissection and Billroth Ⅰ reconstruction for gastric cancer 5 years previously, with a final diagnosis of gastric cancer, M, Less-Ant, 0-Ⅱa, pT1b(SM), pN1(2/52), H0, P0, M0, pStage ⅠB(HER2 IHC 3+). Three years and 6 months after gastrectomy, CT scan showed a splenic tumor, and PET scan also showed FDG accumulation. Diagnosed as splenic metastasis post-gastric cancer surgery, she underwent chemotherapy with S-1, cisplatin, and trastuzumab. After 1 year and 6 months of chemotherapy, the splenic tumor showed mild shrinkage but persisted, leading to the decision for splenectomy due to difficulties in continuing chemotherapy. After laparoscopic splenectomy, intraoperative ICG fluorescence imaging confirmed blood flow in the remaining stomach, so the remnant stomach was preserved. No ischemic complications were observed postoperatively. The final pathology revealed an inflammatory pseudotumor of the spleen, and the patient is under observation. This case highlights successful management of a splenic tumor following distal gastrectomy with preservation of the remnant stomach using laparoscopic splenectomy and intraoperative ICG fluorescence imaging.