What happened, in summary

A 58-year-old man with situs inversus totalis, in which the internal organs are arranged as a mirror image of the usual anatomy, was diagnosed with early gastric cancer. Endoscopy showed a superficial lesion in the upper stomach, and biopsy found poorly differentiated adenocarcinoma. Imaging showed no distant metastases. The cancer was Stage I before surgery.

Because the reversed anatomy could make laparoscopic surgery more difficult, the team used preoperative three-dimensional CT imaging to map the major blood vessels. He underwent laparoscopic-assisted total gastrectomy with standard D1+ lymph-node dissection.

Final pathology showed that the cancer was confined to the stomach lining, with no cancer in the removed lymph nodes. Final pathology also confirmed Stage I disease. He had no immediate postoperative complications and left the hospital 7 days after surgery. Four years later, he was alive without recurrence or symptoms.