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      Adenocarcinoma of the Stomach With Situs Inversus Totalis: A Rare Case

      case-report

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          Abstract

          Situs inversus is a scarce congenital anomaly. Situs inversus totalis (SIT) is a mirroring of the normal. Thoracic and abdominal viscera transposition is a characteristic feature of situs inversus. It is considered to be a premalignant condition. This uncommon genetic disorder is often identified incidentally during thoracic and abdominal imaging. The coexistence of SIT and gastric cancer is rare. Because this anomaly is known to have associated anatomical and vascular anomalies, due care is required to identify it preoperatively and during the surgical procedure. At centers with prior experience, consistent with oncological practices, open surgeries, laparoscopic surgeries, and robotic surgeries can be done.

          We present a patient with a stomach adenocarcinoma with SIT who underwent distal gastrectomy with gastrojejunostomy along with resection and anastomosis of the transverse colon and capecitabin-oxaliplatin chemotherapy. The postoperative course was favorable. To our knowledge, only 13 cases of diffuse-type gastric cancer in a patient with SIT have been reported in the English-language literature.

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          Situs Inversus Totalis: A Clinical Review

          Situs inversus totalis is a rare congenital abnormality characterized by a mirror-image transposition of both the abdominal and the thoracic organs. While this anomaly is known since the ancient times, practicing doctors do not have much experience with it. Laterality is established early in development, and any failure in that process might lead to a wide variety of disorders which may be partial or complete. Situs solitus describes the normal anatomy, situs inversus is the complete reversal, and situs ambiguous is used for any other abnormality of left-right development. Sidedness is regulated by genes: over 100 genes have been linked to laterality defects. Frequency of situs inversus is 1:10,000 and is more frequent in males: 1.5:1. Advanced imaging modalities can be used to assess fine anatomical details, which play a crucial role in these cases to plan radiologic or surgical interventions. Percutaneous biliary procedures, portal vein embolization are really challenging procedures in SIT patients due to the mirror effect. As most surgeons are right-handed, SIT operations can cause difficulties: handling the instruments with their left hand or the pedals with their left foot can be uncomfortable Organ, especially liver transplantation represents an extraordinary surgical challenge. Solutions to overcome the anatomic differences include the use of segment or reduced size graft with rotation, modified piggy-back technique, side to-side caval anastomosis, and vascular conduit. Because of its rarity and special nature, surgical patients with situs inversus may require more flexibility and creativity from the surgical team.
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            Cancer of the gastroesophageal junction: a diagnosis, classification, and management review

            Management of gastroesophageal junction (GEJ) adenocarcinoma is a controversial topic. The rising incidence of this cancer requires a clear consensus to ensure proper management. Application of oncological principles for tumors of the esophagus or stomach is not possible because of comparative differences in the biology of GEJ adenocarcinoma, leading to different therapeutic options. Staging work-up with endoscopy, endosonography, and PET is essential to inform the choice of neoadjuvant treatment and surgical approach to GEJ adenocarcinoma. Surgery remains the only curative treatment and should be undertaken in specialized centers.
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              Situs inversus totalis patients with gastric cancer: Robotic surgery the standard of treatment?-A case report

              • Situs inversus totalis is a very rare congenital anomaly. • Variant anatomy will inevitably conflict with surgical habits. • Minimally invasive surgery for situs inversus totalis patients has more advantages over traditional surgery. Introduction and importance Situs inversus totalis (SIT) is a very rare congenital condition. Situs inversus totalis (SIT) patients who present with gastric cancer have been reported in Japan, China, the United States, and other countries. China has a high incidence of gastric cancer, accounting for 40% of the global annual incidence. Surgical treatment options for situs inversus totalis (SIT) gastric cancer patients are of great concern due to the rare nature of the condition and the anatomical variations. This case aims to demonstrate the utility of robotic surgery in treating situs inversus totalis patients with gastric cancer. Case presentation We report a 69-year-old male situs inversus totalis (SIT) gastric cancer patient who successfully underwent a DaVinci robotic-assisted distal gastrectomy with Roux-en-Y reconstruction. The patient had no complications after the operation and was discharged postoperative day 15. Clinical discussion Gastric cancer is an aggressive disease that requires timely diagnosis and appropriate intervention. Unfortunately, many patients present late with gastric cancer and do not benefit from surgical or other appropriate interventions. Patients who are eligible for surgery however still need a clean marginal resection to maximize prognosis, which is not always possible due to complex anatomy or variations as seen in situs inversus totalis. DaVinci robotic surgery system is a new generation of minimally invasive operating systems after conventional laparoscopy, and its visual field clarity, operating flexibility, and instrument stability have obvious advantages over conventional laparoscopic surgery and traditional open surgery. Conclusion Robotic surgery for situs inversus totalis (SIT) patients is more advantageous than laparoscopic and traditional surgeries as it offers a broader view of the variant anatomy and allows optimum dexterity and clarity.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                15 November 2022
                November 2022
                : 14
                : 11
                : e31538
                Affiliations
                [1 ] General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
                [2 ] Pharmacology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
                Author notes
                Article
                10.7759/cureus.31538
                9754147
                36540458
                685046d6-0ebb-4b00-a834-e87b704b824b
                Copyright © 2022, Lamture et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 October 2022
                : 15 November 2022
                Categories
                Gastroenterology
                General Surgery
                Anatomy

                chemotherapy,gastrectomy,stomach carcinogenesis,metastatic,cancer,gastric adenocarcinoma

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