Robot-Assisted Completion Total Gastrectomy for Remnant Gastric Cancer after Double-Tract Reconstruction with an Intracorporeal Jejunal Delta-Shaped Anastomosis: A Case Report.

INTRODUCTION: Completion total gastrectomy for remnant gastric cancer (RGC) after double-tract (DT) reconstruction is technically demanding because of altered gastrointestinal anatomy and the presence of multiple previous anastomoses. Although minimally invasive approaches have been increasingly adopted, reports describing robot-assisted completion gastrectomy with standardized intracorporeal reconstruction in this setting remain limited. CASE PRESENTATION: A 72-year-old woman with a history of laparoscopic proximal gastrectomy and DT reconstruction for early gastric cancer was diagnosed with RGC located in the gastric antrum. Endoscopic submucosal dissection was initially attempted but was discontinued due to severe submucosal fibrosis. Robot-assisted completion total gastrectomy was subsequently performed using the da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA). After resection of the remnant stomach and the previous gastrojejunostomy, jejunal continuity was restored using an intracorporeal jejunal delta-shaped anastomosis. Indocyanine green fluorescence imaging was utilized to confirm adequate perfusion of the jejunal segments before reconstruction. The operative time was 256 minutes, and the estimated blood loss was 10 mL. The postoperative course was uneventful, and the patient was discharged on POD 13. Histopathological examination revealed well-differentiated adenocarcinoma confined to the mucosa without lymph node metastasis (pT1aN0M0). CONCLUSIONS: Robot-assisted completion total gastrectomy with intracorporeal jejunal delta-shaped anastomosis was safely performed in a patient with RGC after DT reconstruction. This approach may provide a feasible reconstructive option in complex reoperative gastric surgery by enabling precise dissection, secure anastomosis, and reliable assessment of intestinal perfusion.