Robot-Assisted Distal Gastrectomy with Preservation of a Congenital Portosystemic Shunt for Gastric Neuroendocrine Tumor: A Case Report

INTRODUCTION: Gastric neuroendocrine tumors (gNETs) are rare neoplasms; their coexistence with a congenital portosystemic shunt (CPSS) presents unique surgical challenges caused by the risks of intraoperative hemorrhage and postoperative hepatic dysfunction secondary to altered portal hemodynamics. To the best of our knowledge, no reports have described robot-assisted gastrectomy preserving a CPSS during gNET resection. CASE PRESENTATION: A 54-year-old man presented with gastrointestinal hemorrhage and was diagnosed with a gNET (G1). Contrast-enhanced CT revealed a CPSS connecting the left gastric vein (LGV) and left renal vein (LRV) adjacent to the stomach. Given the absence of hepatic dysfunction and the potential risk of portal hypertension after shunt interruption, preservation of the anomalous vessel was planned. Robot-assisted distal gastrectomy with D2 lymphadenectomy was performed. The robotic platform provided stable 3D visualization and facilitated precise dissection around the anomalous vessel, thereby enabling complete tumor resection with adequate margins while preserving the shunt. Histopathological examination confirmed a G1 neuroendocrine tumor, without lymph node metastasis. The postoperative course was uneventful, with no hepatic or oncological complications. CONCLUSIONS: Robot-assisted gastrectomy may facilitate safe and precise resection in selected patients with gNETs concurrent with CPSSs.