Three-dimensional fusion images combining CT gastrography and CT angiography for early gastric cancer: Pilot experiences of preoperative simulation prior to totally laparoscopic gastrectomy

• Published in: Asian journal of endoscopic surgery Vol. 8; no. 1; pp. 54 - 58
• Main Authors: Miyazaki, Shinichiro, Kikuchi, Hirotoshi, Hiramatsu, Yoshihiro, Ozaki, Yusuke, Iino, Ichirota, Ohta, Manabu, Kamiya, Kinji, Sakaguchi, Takanori, Unno, Naoki, Konno, Hiroyuki
• Format: Journal Article
• Language: English
• Published: Japan Blackwell Publishing Ltd 01.02.2015; Wiley Subscription Services, Inc
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - surgery; Angiography - methods; Computed tomographic gastrography; Diagnosis, Differential; Female; Gastrectomy - methods; Gastric cancer; Humans; Imaging, Three-Dimensional - methods; Laparoscopy; Medical imaging; Middle Aged; Neoplasm Staging - methods; Pilot Projects; Preoperative Care - methods; Simulation; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - surgery; Tomography, X-Ray Computed; totally laparoscopic gastrectomy; gastric cancer; totally laparoscopic gastrectomy; Computed tomographic gastrography
• ISSN: 1758-5902; 1758-5910
• DOI: 10.1111/ases.12147

We herein report two cases of gastric cancer in which preoperative 3‐D CT gastrography and CT angiography fusion images enabled totally laparoscopic gastrectomy. Case 1 involved a 60‐year‐old woman with a superficial depressed lesion on the greater curvature of the middle gastric body. Case 2 involved a 64‐year‐old woman with a superficial depressed lesion on the posterior wall of the upper gastric body. In both cases, 3‐D fusion images were prepared from enhanced CT scans after the area near the lesions was clipped under preoperative gastroendoscopy. Based on the relative position between the clips and nearby vessels, a resection line was preoperatively determined in each case. Totally laparoscopic distal gastrectomy and totally laparoscopic proximal gastrectomy were performed in cases 1 and 2, respectively, with safe surgical margins. Three‐dimensional fusion images can help in preoperative simulation of totally laparoscopic gastrectomy.