D2 lymph node dissection for early gastric cancer was popularized by the Japanese, though it is still controversial. The adequacy of laparoscopic node harvest remains doubtful. In this video, we present a laparoscopic D2 dissection with total gastrectomy and jejunal pouch anastomosis.
Methods: We have performed this procedure in 82 patients from 2002-2007. The dissection was commenced from disconnecting the greater omentum off of the transverse colon, proceeding to clear the nodes at the splenic hilum (#10), gastrocolic (#6), nodes around superior mesenteric vein (#14v), and subpyloric nodes. Next, the duodenum was transected and the hepatoduodenal (#12a & 5), celiac axis (#9), and nodes around portal vein (#8p) were cleared. The nodes around left gastric artery (#7) were then cleared, and the dissection was continued up to the median arcuate ligament to clear nodes at the gastroesophageal junction (#1& 2). Nodes around the splenic artery (#11) were cleared. At this point, the esophagus is divided at the junction with a stapler. Esophageal-pouch anastomosis was performed laparoscopically, while the pouch construction was done extracorporeally.
Results: The mean age of the patients was 51 years, and mean operating time was 232.5 minutes, and average blood loss was 185ml. The mean hospital stay was 8 days. Postoperative complications included ileus (n=5), deep vein thrombosis (n=2), pneumonitis (n=4), hemorrhage (n=3) and anastomotic leak (n=2). There were no conversions or mortality.
Conclusion: Laparoscopic D2 dissection with total gastrectomy and jejunal pouch anastomosis is safe and feasible. It is comparable with the open technique regarding lymph node harvest, and superior because of lower morbidity.
Session: Podium Video Presentation
Program Number: V046