Wei Wang, MD, Wenjun Xiong, MD, Lijie Luo, Yansheng Zheng, Jin Wan. Guangdong Provincial Hospital of Chinese Medicine
The primary results of JCOG1001 had shown that bursectomy can be safely performed without increasing morbidity and mortality, but bursectomy can not improve 3-years survival for patients with advanced gastric cancer. However, the significance of bursectomy for advanced gastric cancer located at the posterior stomach wall is still unknown. Herein, we introduce the technique of laparoscopic D2 radical total gastrectomy to achieve complete bursectomy for advanced gastric cancer at the posterior wall.
First step was identifying the left peritoneum line and dissecting the anterior lobe of transverse mesocolon and the capsule of pancreas from left to right. The superior border of pancreas was exposed and the outside omentalis space was expanded from left to right with the No.4sb, 4sa, 11 and 10 lymph nodes (LNs) dissection. The posterior wall of bursa omentalis was dissected from pancreatic tail to pancreatic neck with the abdominal aorta, celiac trunk and its branches were exposed and the No.2, 7, 8a and 9 lymph nodes were dissected. Exposing the right gastric artery and portal vein, the No.5 and 12a LNs were dissected. Then a piece of guaze was placed at the back of duodenum for introduction.
Secondly, the right part of the anterior lobe of transverse mesocolon was separate to expose the duodenum and pancreas head with No.6 LNs dissection. The capsule of pancreas head was dissected to expand the outside bursa omentalis space and the gauze for introduction was indentified. The two side of outside bursa omentalis space were combined. With the introduction of separated anterior-pancreatic space, the middle part of the anterior lobe of transverse mesocolon was dissected.
The third step was separating the anterior wall of the lesser bursa omentalis to dissect No.1, 3 and 5 LNs. The mobilizing and dissecting procedure was finished and complete bursectomy was accomplished.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85826
Program Number: V097
Presentation Session: Friday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo