[A Case Report of Robot-Assisted Laparoscopic Distal Gastrectomy for Gastric Cancer with Concurrent Malignant...

The patient was a woman in her 70s. Screening endoscopy revealed a 0-Ⅱc lesion on the lesser curvature of the gastric antrum, and biopsy confirmed a well-differentiated tubular adenocarcinoma (tub1). Endoscopic submucosal dissection (ESD) was performed; however, pathological findings indicated non-curative resection (eCura C-2). She was referred to our department for additional surgical treatment. Preoperative computed tomography showed mild enlargement of mesenteric lymph nodes, with no enlargement of regional lymph nodes. A robot-assisted laparoscopic distal gastrectomy with D2 lymph node dissection was planned using the Da Vinci X system. Intraoperatively, clustered small lymph nodes were noted at station #6. One was excised and submitted for intraoperative rapid diagnosis, which revealed no evidence of metastasis. Based on this result, D2 dissection was carried out as planned. The operation was completed without complications, and the patient was discharged on postoperative day 8. Histopathological examination revealed no residual gastric carcinoma or lymph node metastasis; however, immunohistochemical analysis of the lymph nodes revealed features consistent with follicular lymphoma (Grade 1). As the patient had no systemic symptoms or high tumor burden, a watch-and-wait strategy was adopted. This case highlights the utility of robot-assisted surgery in safely excising enlarged lymph nodes and guiding the extent of lymphadenectomy.