Laparoscopic D2 radical gastrectomy plus complete mesogastrium excision with membrane anatomy

Jianping Gong, Daxing Xie, Yixin Tong. Tongji hospital

Background: D2 gastrectomy has been widely accepted as a standard procedure for surgical treatment of local advanced gastric cancer. However, neither the boundary nor the extent of the excision for perigastric soft tissues has been described. By employing video laparoscopy, we demonstrated that mesogastrium, covered by Proper Fascia with anterior surface (A) and posterior surface (P), extends towards and fuses with the “mesogastrium bed”. Therefore, D2 lymphadenectomy plus complete mesogastrium excision (CME) is proposed as a novel approach to en bloc for advanced gastric cancer. The mobilization of mesogastrium from the mesogastrium bed in laparoscopic D2 plus CME may facilitate the standardization of D2 radical surgery and improve the prognosis of advanced gastric cancer patients.

Method: All participants provided informed written consent to participate in the study. A total of 54 patients underwent laparoscopic D2+CME with membrane anatomy. This study was approved by the Tongji Hospital Ethics Committee.

Results: A total of 54 patients underwent laparoscopic D2+CME with membrane anatomy. The mean number of retrieved regional lymph nodes was 35.04±10.70 (ranges 14-55 lymph nodes). The mean volume of blood loss was 12.44±22.89 ml. The mean laparoscopic surgery time was 127.82±17.63 mins (ranges 110-165 mins). The mean hospitalization time was 11.09±4.28 days (ranges 8-28 days). No operative complication was observed during hospitalization.

Conclusion: We believe that the laparoscopic D2 plus CME can minimize the differences in the number of lymph nodes harvested, and substantially reduce the intraoperative blood losses and surgery-related injuries in advanced gastric cancer patients.

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