A novel function preserving management for adenocarcinoma of the esophagogastric junction with severe muscular dystrophy and benign pyloric stenosis in an elderly patient: a case report

Abstract Background Due to its nutritional advantages over total gastrectomy, proximal gastrectomy with anti-reflux techniques has gained significant attention in East Asian countries in recent years. Seromuscular flap valvuloplasty, represented by double flap technique and right-sided overlap with single flap valvoplasty, has become an emerging anti-reflux procedure and proven its superiority in clinical practice. Although more high-quality studies are needed. We present a patient (AEG, Siewert type II) with severe muscular dystrophy and pyloric stenosis who underwent reduced-port laparoscopic proximal gastrectomy followed by ROSF and gastrojejunostomy. Case summary A 72-year-old male complaining of “epigastric distension for 1 month and vomiting for 1 day” was diagnosed with adenocarcinoma of the esophagogastric junction (AEG, Siewert II) and pyloric ulcer-associated stenosis. He was also diagnosed with progressive muscular dystrophy 40 years ago. We designed ROSF and gastrojejunostomy after RPLPG to balance oncologic safety and nutritional prognosis. He recovered well and was successfully discharged 10 days after surgery (total hospitalization was 24 days). During his hospitalization and follow-up period, we provided him with trimodal prehabilitation (continuous nutritional guidance, exercise rehabilitation guidance and psychological guidance). The patient’s nutritional status and motor function improved over the preoperative period during the 10-month follow-up period. Conclusion ROSF combined with trimodal prehabilitation may be of great advantage in improving postoperative nutritional status and motor function for patients with Siewert II AEG. ROSF combined with gastrojejunostomy is safe and effective in the treatment of patients with AEG (Siewert type II) and pyloric stenosis or obstruction.