Laparoscopic Distal Gastrectomy With D2 Lymphadenectomy and Total Omentobursectomy for Advanced Gastric Cancer

Young-kyu Park, MD PhD, Oh Jeong, MD, Mi-ran Jung, MD, Jang-won Sun, MD, Kwang-yong Kim, Seong-yeob Ryu, MD PhD. Chonnam National University Hwasun Hospital


Introduction: Laparoscopic gastrectomy has been widely accepted for the treatment of early gastric cancer (EGC) in Korea and Japan. However, it is still debating whether AGCs can be treated with laparoscopic surgery in the same way as used for EGCs, because of the concerns about technical difficulties and oncological safety, which are mostly caused by large and deep penetrating tumor, fragile metastatic lymph node, and easy bleeding in AGCs.
Methods: We developed the technique of laparoscopic D2 lymphadenectomy and omentobursectomy for AGCs, emphasizing no touch and en-bloc dissection principles, and herein present the representative video of our procedure. Surgical outcomes were also evaluated for 36 AGC patients who underwent this procedure from January 2010 to August 2011.
Results: There were 23 males and 13 females with mean age of 58.9 years. Of the 36 patients, 6 (16%) had a history of abdominal surgery, and mean BMI was 23.5 ± 2.9 kg/m2. Thirty-five (97%) underwent R0 resection. Mean operating time was 225 ± 61.7 min, and intraoperative blood loss was 167 ± 129 ml. In the final pathologic report, there were stage II, III, and IV of 20 (55.6%), 15 (41.7%), and 1 (2.8%) patient, respectively. Mean tumor size was 41.4 ± 18.5 mm and proximal resection margin was 44 ± 23 mm. Mean number of harvested lymph nodes was 39.8 ± 12.5. The mean length of hospital stay was 8.4 ± 2.8 days. Postoperative complications, such as anastomosis leakage and luminal bleeding, occurred in 3 (8.1%) patients, and there was no hospital mortality.
Conclusions: Despites large deep penetrating tumor and extensive lymph node metastasis in AGCs, laparoscopic D2 lymphadenectomy with total omentobursectomy could be performed with technical feasibility and oncological safety, provided no touch and en-bloc dissection technique.

Session Number: VidTV3 – Video Channel Rotation Day 3
Program Number: V130

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