This case demonstrates robotic staging laparoscopy and feeding jejunostomy placement for nutritional support in a patient with gastroesophageal junction (GEJ) adenocarcinoma causing progressive dysphagia and cancer-associated malnutrition.

The patient presented with grade 3 dysphagia and weight loss and was found to have biopsy-proven GEJ adenocarcinoma characterized by microsatellite stability (MSS) and PD-L1 CPS 3, with HER2 status pending at the time of evaluation. Cross-sectional imaging and PET/CT demonstrated a hypermetabolic GEJ mass with thoracic, abdominal, and retroperitoneal lymphadenopathy, as well as indeterminate pulmonary nodules suspicious for metastatic disease.

Evaluation also identified a synchronous descending colon adenocarcinoma, further complicating oncologic management.

Because of the patient’s multiple comorbidities, frailty, and marginal performance status (ECOG 2–3), definitive surgical resection was not appropriate. Multidisciplinary evaluation recommended systemic therapy and/or definitive chemoradiation. However, the patient’s progressive dysphagia and declining nutritional status required long-term enteral access prior to treatment.

A robotic staging laparoscopy was performed to evaluate for occult peritoneal metastases. No intra-abdominal metastatic disease was identified. A feeding jejunostomy tube was then placed robotically by securing a loop of proximal jejunum to the abdominal wall and inserting a 16-French jejunostomy tube using a purse-string and circumferential fixation technique.

The patient recovered well and was discharged home the same day.

Feeding jejunostomy placement is a commonly performed procedure in patients with esophageal and gastroesophageal junction cancers who develop significant dysphagia, allowing reliable enteral nutrition during systemic therapy or chemoradiation.

This video demonstrates robotic techniques for laparoscopic staging and jejunostomy placement in the multidisciplinary management of advanced upper gastrointestinal malignancies.