Surgery on Gastric Cancer with Situs Inversus Totalis: Case Report and Update

Authors
Fu Hong, Liang Yun Jia, Sun Bo, Liu Feng Lin

Affiliations
Department of Gastric Surgery, Fudan University, Shanghai Cancer Center, 200032, Shanghai, People’s Republic of CHINA

Introduction
Gastric cancer (GC) is the 5th most prevalent cancer and the 3rd deadly cause of cancer-related mortality worldwide. It has been a routine to mobilize surgical care for relevant stages on different GCs in terms of guideline. But there are quite unique challenges when practiced on certain surgical procedures on a GC with situs inversus totalis (SIT), which is an uncommon disorder featured by mirror/image anatomy with potential vascular anomalies in surgical intervention.

Methods
A 39-year-old male was hospitalized for a pathology confirmed antrum cancer, cT2N0M0 with SIT. The 3*2 cm tumor was 2/3 cycle around antrum with slightly 2 months obstruction. A D2/R0 distal gastrectomy of Billroth II plus Braun anastomosis finished and postoperative pathology revealed moderately to poorly differentiated adenocarcinoma(p T3N0M0).

Results
He discharged at 7 POD and followed up 12 months well with S1 adjuvant chemotherapy for 6 months. We analyzed his clinical feature on surgical mobilization and update the literature.

Conclusion
There are 49 cases reported with GC on SIT in 47 articles from 2000- 2023. The literature revealed 20% of vascular anomalies, accentuating its surgical significance. All underwent certain cares including open, lapa, robotic, and ESD. An intensive understating and meticulous preoperative planning on GC with SIT provide solid measure to face inherent challenges, underscoring the imperativeness of future research in this niche domain.