Abstract
Laparoscopy-assisted distal gastrectomy (LADG) with extended lymph node dissection has not yet been widely adopted for the treatment of gastric cancers because of the perceived complexity of the procedure. Suprapancreatic lymph node dissection is one of the most important and demanding procedures in this approach. The techniques of duodenal transection within the abdominal cavity or taping of the common hepatic or splenic artery had traditionally been adopted for suprapancreatic nodal dissection during open surgery. In 2005, we developed a new laparoscopic procedure to safely and simply perform suprapancreatic lymph node dissection in LADG. We introduced a left-sided approach for the dissection of lymph nodes in the left gastropancreatic fold, where the body of the stomach is turned over and lifted ventrally to expose the left gastropancreatic fold through the opened lesser sac, without duodenal transection, and the suprapancreatic lymph nodes are resected en bloc in reverse order, i.e., including the lymph nodes along the proximal splenic artery (station 11p), around the celiac artery (station 9), and along the common hepatic artery (station 8a). Between April 2005 and December 2007, a total of 391 patients with cT1,2 gastric cancer underwent this surgical approach. In all patients, surgery was completed safely with favorable outcomes; mean operating time was 239 min and mean blood loss was 63 ml. The complication rate was 4.6% (18/391); there were ten conversions (2.6%) and no mortality. The aim of the present study was to describe the surgical technique of our new approach for LADG with extended lymph node dissection and to evaluate the treatment outcomes achieved by this technique.
Article PDF
Similar content being viewed by others
References
Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer 2007;10:1–11.
Uyama I, Sugioka A, Matui H, Fujita J, Komori Y, Hasumi A. Laparoscopic D2 lymph node dissection for advanced gastric cancer located in the middle or lower third portion of the stomach. Gastric Cancer 2000;3:50–55.
Tanimura S, Hagashino M, Fukunaga Y, Osugi H. Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Gastric Cancer 2003;6:64–68.
Fujiwara M, Kodera Y, Kasai Y, Kanyama Y, Hibi K, Ito K, et al. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma: a review of 43 cases. J Am Coll Surg 2003;196:75–81.
Lee JH, Kim YW, Ryu KW, Lee JR, Kim CG, Choi IJ, et al. A phase-II clinical trial of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer patients. Ann Surg Oncol 2007;14:3148–3153.
Noshiro H, Nagai E, Shimizu S, Uchiyama A, Tanaka M. Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer. Surg Endosc 2005;19:1592–1596.
Ryu KW, Kim YW, Lee JH, Nam BH, Kook MC, Choi IJ, et al. Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol 2008;15:1625–1631.
Japanese Gastric Cancer Association. Gastric cancer treatment guideline (in Japanese). 2nd ed. Tokyo: Kanehara-Shuppan; 2004.
Song KY, Kim SN, Park CH. Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects. Surg Endosc 2008;22:655–659.
Author information
Authors and Affiliations
Electronic supplementary material
Supplementary material, approximately 443 MB.
Rights and permissions
About this article
Cite this article
Fukunaga, T., Hiki, N., Tokunaga, M. et al. Left-sided approach for suprapancreatic lymph node dissection in laparoscopy-assisted distal gastrectomy without duodenal transection. Gastric Cancer 12, 106–112 (2009). https://doi.org/10.1007/s10120-009-0508-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10120-009-0508-9