{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T16:42:47Z","timestamp":1786207367972,"version":"build-2736575974"},"reference-count":5,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T00:00:00Z","timestamp":1781395200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T00:00:00Z","timestamp":1781395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000098","name":"Clinical Center","doi-asserted-by":"publisher","award":["T32 CA 009599"],"award-info":[{"award-number":["T32 CA 009599"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The University of Texas MD Anderson Cancer Center support grant","award":["P30 CA016672"],"award-info":[{"award-number":["P30 CA016672"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Locally advanced gastroesophageal junction (GEJ) tumors are surgically challenging, requiring balance between R0 resection and preserving quality of life.\n                      <jats:sup>1<\/jats:sup>\n                      Total gastrectomy has been the standard approach, but function-preserving strategies are increasingly used to mitigate the nutritional and hormonal consequences associated with complete stomach removal.\n                      <jats:sup>2<\/jats:sup>\n                      Proximal gastrectomy (PG) with esophagogastric anastomosis preserves gastric volume but is frequently complicated by severe reflux and anastomotic strictures.\n                      <jats:sup>3<\/jats:sup>\n                      Double-tract reconstruction (DTR) has emerged as an alternative. Recent meta-analyses have demonstrated that DTR reduces reflux and stricture rates compared with esophagogastric anastomosis while maintaining 5-year overall survival comparable with total gastrectomy.\n                      <jats:sup>4,5<\/jats:sup>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study demonstrated robotic PG-DTR and en bloc distal pancreatectomy with splenectomy (DPS) for a 70-year-old man with Siewert type II GEJ adenocarcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>After a favorable response to neoadjuvant FOLFOX chemotherapy, the patient underwent resection. The case was completed in less than 6 h. Pathology showed a 6.3-cm, moderately differentiated T4bN2 adenocarcinoma. Despite advanced-stage disease and indications of peritoneal spread, the patient had prompt recovery (Fig. 1). Key considerations included careful patient selection after preoperative chemotherapy and achievement of R0 resection with meticulous mediastinal and oncologic lymph node dissection. For optimal functional outcomes and prevention of internal hernias, the authors perform hand-sewn esophagojejunostomy, appropriate spacing between the esophagojejunostomy and gastrojejunostomy, upright fixation of the remnant stomach, and closure of the hiatal, mesenteric, and Petersen defects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case demonstrates that PG-DTR and en bloc DPS are feasible and may provide functional benefits for select patients who have locally advanced GEJ tumors with direct pancreatic invasion. The robotic approach may enhance postoperative recovery, supporting early resumption of systemic therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-19875-9","type":"journal-article","created":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T21:41:55Z","timestamp":1781473315000},"page":"8348-8349","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Robotic Multivisceral Resection for Gastroesophageal Junction Tumor: Proximal Gastrectomy with Double-Tract Reconstruction and Distal Pancreatectomy"],"prefix":"10.1245","volume":"33","author":[{"given":"Anneliese N.","family":"Hierl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taisuke","family":"Imamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian D.","family":"Badgwell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul F.","family":"Mansfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naruhiko","family":"Ikoma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,14]]},"reference":[{"key":"19875_CR1","doi-asserted-by":"publisher","first-page":"2014","DOI":"10.21873\/invivo.12927","volume":"36","author":"D Symeonidis","year":"2022","unstructured":"Symeonidis D, Zacharoulis D, Kissa L, Samara AA, Bompou E, Tepetes K. Gastric cancer invading the pancreas: a review of the role of pancreatectomy. In Vivo. 2022;36:2014\u20139.","journal-title":"In Vivo."},{"key":"19875_CR2","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.1245\/s10434-015-5065-3","volume":"23","author":"JL Davis","year":"2016","unstructured":"Davis JL, Selby LV, Chou JF, et al. Patterns and predictors of weight loss after gastrectomy for cancer. Ann Surg Oncol. 2016;23:1639\u201345. https:\/\/doi.org\/10.1245\/s10434-015-5065-3.","journal-title":"Ann Surg Oncol."},{"key":"19875_CR3","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1007\/s10120-018-0804-3","volume":"21","author":"F Rosa","year":"2018","unstructured":"Rosa F, Quero G, Fiorillo C, et al. Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach: a propensity score-matched analysis of a multicenter western experience (on behalf of the Italian Research Group for Gastric Cancer-GIRCG). Gastric Cancer. 2018;21:845\u201352.","journal-title":"Gastric Cancer."},{"key":"19875_CR4","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1186\/s12876-024-03323-7","volume":"24","author":"G Zhu","year":"2024","unstructured":"Zhu G, Jiao X, Zhou S, et al. Can proximal gastrectomy with double-tract reconstruction replace total gastrectomy? A meta-analysis of randomized controlled trials and propensity score-matched studies. BMC Gastroenterol. 2024;24:230.","journal-title":"BMC Gastroenterol."},{"key":"19875_CR5","doi-asserted-by":"publisher","first-page":"621","DOI":"10.5230\/jgc.2025.25.e44","volume":"25","author":"HJ Lee","year":"2025","unstructured":"Lee HJ, Kim JC, Kim SH, et al. Clinical outcomes according to surgical strategies in proximal early gastric cancer: a systematic review and network meta-analysis. J Gastric Cancer. 2025;25:621\u201338.","journal-title":"J Gastric Cancer."}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-19875-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1245\/s10434-026-19875-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-19875-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T15:49:15Z","timestamp":1786204155000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1245\/s10434-026-19875-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,14]]},"references-count":5,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["19875"],"URL":"https:\/\/doi.org\/10.1245\/s10434-026-19875-9","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,14]]},"assertion":[{"value":"30 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Anneliese N. Hierl is supported by the National Institutes of Health (T32 CA 009599) and The University of Texas MD Anderson Cancer Center support grant P30 CA016672. The remaining authors have no conflicts of interest.","order":1,"name":"Ethics","label":"Disclosure","group":{"name":"EthicsHeading","label":"Ethics"}}]}}