Laparoscopic Combined Gastric Cancer and Rectal Cancer Resection with Transanal Specimen Extraction

Abstract

Multiple primary malignant neoplasms (MPMNs) are defined as two or more malignancies of the same or different pathological types occurring simultaneously or successively within the same individual. Among these, malignancies that occur simultaneously in the stomach and colorectum are known as gastrointestinal MPMNs. The advancements in laparoscopic techniques and total laparoscopic anastomosis facilitate reconstructive anastomosis and specimen extraction via a natural orifice. Cases of laparoscopic radical resection for gastrointestinal MPMNs, followed by natural orifice specimen extraction surgery (NOSES) without additional abdominal incisions, have rarely been reported. The author’s surgical team has previously completed one case of laparoscopic local gastric stromal tumor resection and radical rectal cancer resection with NOSES IV (transrectal extraction of gastric stromal tumor), as well as one case of combined laparoscopic distal gastrectomy and radical rectal cancer resection with NOSES IB (transrectal extraction of gastric cancer specimen). The success of NOSES for gastrointestinal MPMNs depends on the location, size, and stage of the individual tumors. Radical tumor resection must comply with the principles of aseptic and tumor-free operations while also meeting the conditions for NOSES. In this chapter, we will describe a case of combined laparoscopic distal gastrectomy and radical rectal cancer resection with NOSES IB to illustrate our preliminary experiences in NOSES for gastrointestinal MPMNs.