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Intracorporeal esophagojejunostomy after total or proximal robot-assisted gastrectomy is technically more demanding than gastroduodenostomy and gastrojejunostomy for distal gastrectomy, as well as laparoscopic surgery. We have established a safe and simple esophagojejunostomy procedure using a liner stapler attached to the Da Vinci Surgical System and a barbed suture device., Patients and Methods: For esophagojejunostomy after total gastrectomy or proximal gastrectomy with double-tract reconstruction, we choose the "overlap method," in which entry holes were made at the left of the esophageal stump and at 5 cm of the anal side in antimesentric area of the jejunum, followed by anastomosis on the left of the esophagus using SureForm (blue 45 mm) and hand-sewing closure of the common entry hole with V-Loc. We analyzed the short-term surgical outcomes of all patients., Results: 23 patients underwent this reconstruction technique. None of the patients required any further open surgeries. The mean time to perform anastomosis was 24.7±2.8 min. The postoperative course was uneventful in 22 patients; a single patient developed minor anastomotic leakage (Clavien-Dindo grade 3), which was treated with conservative therapy employing a drainage tube., Conclusion: Our esophagojejunostomy method following robot-assisted gastrectomy is simple and feasible, with acceptable short-term outcomes, and could represent the procedure of choice for esophagojejunostomy., Competing Interests: The authors declare that they have no financial conflict of interest with regard to the content of this report., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Primary gastrointestinal lymphoma is relatively rare and typically treated by chemotherapy. In some cases, surgery for obstruction in the proximal small intestine is challenging and has a high risk for anastomotic leakage. An 80-year-old woman presented to our hospital with vomiting and abdominal distension. Enteroscopy showed a type 2 circumferential tumor in the proximal jejunum 6 cm on the anal side from Treitz ligament. Biopsy showed solid and diffuse proliferation of large atypical cells with round and irregular nuclei. On immunohistochemistry, these cells were positive for CD20, CD79a, and CD138. Diffuse large B-cell lymphoma (DLBCL) was diagnosed and classified as Ann Arbor stage IIE and Lugano classification stage II 2 and scored 1 point on the International Prognostic Index (i.e., low risk). Given the risk of anastomotic leakage due to lesions and residual obstructive enteritis, surgery was not performed. The patient received double percutaneous transesophageal gastrotubing (dPTEG) to facilitate decompression and enteral nutrition. Enteral nutrition and chemotherapy were initiated immediately after dPTEG insertion. After one course of rituximab plus cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (R-CHOP), the tumor showed a partial response, and the obstruction was improved. Oral ingestion was started, and the dPTEG tube was removed. After six courses of R-CHOP, enhanced CT, positron emission tomography-CT, and serum interleukin-2 levels indicated complete treatment response. During treatment, gastrointestinal perforation did not occur, oral intake was good, and careful follow-up will be continued. dPTEG for obstructive small intestinal DLBCL could help avoid high-risk surgery, and a complete response to chemotherapy was achieved., Competing Interests: The authors declare that they have no competing interests., (© 2021 The Authors.)

Introduction: We report a case of sustained complete response in unfavorable cancer of unknown primary site (CUP) successfully treated with chemotherapy combining pembrolizumab, pemetrexed and platinum., Case Presentation: A 66-year-old man was presented with weight loss and cough for 3 months. Contrast-enhanced computed tomography (CT) confirmed a mass in the superior anterior mediastinum and multiple enlarged mediastinal and axillary lymph nodes. Positron emission tomography-CT (PET-CT) showed abnormal uptake in the corresponding lesions. Histopathological analysis of the left axillary nodule revealed poorly differentiated adenocarcinoma. Immunohistochemistry showed the tumor cells were positive for cytokeratin 7 and thyroid transcription factor-1 and negative for cytokeratin 20. Thus, the patient was diagnosed as poorly differentiated adenocarcinoma of unknown primary, and treated as non-small-cell lung cancer. Additional genetic testing revealed the patient was negative for EGFR, ALK fluorescence in situ hybridization, ROS1, BRAF, and PD-L1 22C3 IHC with Tumor Proportion Score (TPS) was less than 1%. The patient received six cycles of pembrolizumab, platinum, and pemetrexed intravenously. Cisplatin was switched to carboplatin because of cisplatin nephrotoxicity in one course. PET-CT after six cycles showed all lesions disappeared; complete response was considered to have been achieved. Maintenance therapy of pembrolizumab and pemetrexed has been continued for 6 months after the induction therapies to prevent progressive disease. Complete response has been maintained., Discussion: Chemotherapy with pembrolizumab, platinum and pemetrexed could be valuable for treating unfavorable CUP., Conclusion: Chemotherapy with pembrolizumab, platinum, and pemetrexed helped achieved sustained complete response in a patient with unfavorable CUP., Competing Interests: There are no conflicts of interest., (© 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Introduction: We investigated the validity of the clinical pathway of early oral intake using a special type of food "iEat™" for patients after laparoscopic gastric cancer surgery., Methods: Fifty-two patients who underwent laparoscopic surgery for gastric cancer between April 2012 and October 2013 were the participants. We provided postoperative care in accordance with a clinical pathway for laparoscopic gastrectomy that begins oral intake with "iEat™ the day after surgery. We examined complications resulting from oral intake, postoperative complications, and the length of postoperative hospital stay., Results: Of the 52 patients, 30 underwent distal gastrectomy and 22 underwent total gastrectomy. 50 patients was able to start early oral intake in accordance with our clinical pathway. No anastomotic leak complications were observed, and 9 patients (17.3%) developed complications as results of surgery. There was no complication related to early oral intake with "iEat™". Re-operation were performed in two cases. Overall mean and median postoperative hospital stays were 8.3 days and 6 days, respectively. There was a single case of hospital re-admission. The completion rate of this early oral intake clinical pathway was 86.5%., Conclusion: Clinical pathway of recovery program combined laparoscopic suregry and early oral intake with "iEat™" could be useful for gastric cancer. This study indicates that using non-liquid food like iEat™ can be feasiblel, and water or liquid food don't have to be used in early oral feeding after laparoscopic gastrectomy.