T Fukunaga, PhD MD, J Sakurai, MD, T Enomoto, MD, S Katayama, MD, J Shimada, MD, R Kyoi, MD, N Miyajima, PhD MD, T Ohtsubo, PhD MD. Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine
Laparoscopic total gastrectomy (LTG) with extended lymph node(LN) dissection has not yet been widely adopted for the treatment of gastric cancers because of the perceived complexity of the procedure. Suprapancreatic LN dissection and Esophagojejunal anastomosis are the important and demanding procedures in this approach.
For suprapancreatic LN dissection, a left-sided approach to the left gastropancreatic fold that we developed in 2005 is employed. In this method, an assistant tracts the left gastropancreatic fold ventrally, and left-to-right dissection, in the order of No. 11p, left gastric artery and vein, No. 9 and No. 8a, is available. When additional LN dissection of No. 11d and 10 are needed, the pancreas and spleen are mobilized within the abdominal cavity and lymph nodes are dissected extracorporeally. For reconstruction, esophagojejunostomy is performed intracorporeally without being influenced by patients’ body shape. For esophagojejunostomy, a hemi-double stapling technique with trans-oral placement of the anvil introduced in 2001 is used. Since 2007, we use OrVil that was developed for trans-oral delivery.
Results: Since April 2004, a total of 130 patients underwent this surgical approach. Mean operating time was 275 ± 65 min. Blood loss was 61 ± 67 ml. A conversion to open surgery associated with bleeding was not required in any of the cases. Mean duration of hospitalization was 19 ± 11 days. Conclusion: With our new approaches, LTG had been performed safely and its short-term result was favorable.
Program Number: P435