[A Case of Local Gastrectomy for Gastric Cancer in a Patient with Post-Peritonitis Skin Grafting and Double Stoma...

A 77-year-old man was referred for treatment of a type 3 lesion located on the greater curvature of the gastric angle, which was detected by esophagogastroduodenoscopy. CT imaging showed no evidence of lymph node metastasis or distant metastases; and the clinical stage was cT2N0M0, cStage Ⅰ. The patient had a complex surgical history, including radical cystectomy with ileal conduit creation for invasive bladder cancer, followed by emergency surgeries for rectal perforation, which was managed with peritoneal lavage and drainage, and sigmoid colostomy. He also had another emergency surgery for perforation of sigmoid colon. Negative pressure wound therapy and subsequent skin grafting were performed for abdominal closure. Comorbidities included variant angina, asthma, and restrictive pulmonary dysfunction. Due to anticipated extensive adhesions, the limited access to the abdominal cavity, and the patient's poor ADL, a standard gastrectomy was not feasible. Local gastrectomy with limited lymphadenectomy was successfully performed. Pathology revealed adenocarcinoma, pT3N0M0, pStage ⅡA. The patient recovered without major complications. This case highlights the feasibility of performing local gastrectomy in high-risk patients with limited surgical access.