Dechang Diao, MD, Xinquan Lu, MD, Xiaojiang Yi, MD, Hongming Li, MD, Jin Wan, MD. Department of Gastrointestinal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine
Background In recent years, with the further study of the metastasis of gastric cancer and the improvement of the understanding of gastric mesangial anatomy, many scholars have come to realize that D2 procedure based on lymphatic adipose tissue dissection may not be enough. The concept of operation based on mesenteric anatomy is proposed. Herein, we described a “mesentery oriented” approach for Laparoscopic radical distal gastrectomy (mo-LRDG) for Gastric cancer.
Methods Clinical data of 108 cases of LRDG for gastric cancer from January 2017 to May 2018 were analyzed retrospectively. 54 cases were included in the mo-LRDG group, which was compared with 54 cases with conventional standard approach (cs-LRDG). For mo-LRDG group, our method was to lift the dorsal mesentery of the stomach, and show the Tri-junction between the dorsal mesentery and the transverse colon for cutting off the membrane bridge and expanding to the right in the confluent fascial space. We exposed and resected at the root of the right mesentery of the gastroepiploon, and cleared the lymph nodes (LNs) of NO.11d and NO.4sa. Continue to expand to the right of Tri-junction, the right mesentery of gastric omentum was cut off at the root, and NO. 6 LNs were removed. To the left, NO.7, 8a, 9 LNs were cleared from the left mesentery and the roots were severed. NO.5 LNs were cleared by exposing the right mesentery. The NO.1 LNs were removed by the naked proximal stomach. Finally, we took a 5-cm auxiliary incision on the upper abdomen for B-I anastomosis.
Results The mean operation time was without statistical significance between the mo-LRDG and cs-LRDG groups (181.5 vs 185.3 min, p>0.05) and it was the same with the mean blood loss (105.4 vs 107.5 ml, p>0.05). The mean number of harvested LNs was 29.3 in mo-LRDG group, compared with 26.2 in cs-LRDG group (p=0.06). There were 2 cases of conversion in mo-LRDG group and 3 cases in cs-LRDG group. Postoperative hemorrhage was occurred in 1 patients in both groups (p>0.05), and no post-operative mortality was observed.
Conclusion The initial results suggest that the “mesentery oriented” approach for mo-LRDG may be a feasible and safe procedure. It may have some advantages in postoperative recovery and lymph nodes harvest.
Key words: Mesentery Oriented; Laparoscopic Radical Distal Gastrectomy; Gastric cancer
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95145
Program Number: V174
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop