Introduction) Laparoscopy-assisted gastrectomy including lymph nodes dissection consists of complicated procedures. The aim of this study is to clarify the utility of preoperative evaluation using 3D-CT and standardization of the procedures.
Patients and methods) The 50 patients with gastric cancer (Stage I: 40, Stage II: 4, StageIIIA: 3, Stage IV: 3 Japanese Classification of Gastric Carcinoma) performed laparoscopy-assisted gastrectomy (distal gastrectomy: 46, total gastrectomy: 4) were divided into four groups. The 9 patients were Group 1 after the introduction of laparoscopic surgery in 2001. After April, 2004 Hand Assisted Laparoscopic Surgery (HALS) was introduced for the 9 patients in the Group 2. Since January, 2005, the procedures have been standardized for 32 patients in the Gourp 3 and 4, 1.Division of left gastroepiploic vessels 2. Division of right gastroepiploic vessels and No. 6 lymph node dissection, 3 Division of duodenum, 4. Division of right gastric artery and No. 5 lymph node dissection, 5. Exposure of right crus of diaphragm, 6. Division of left gastric artery and No. 7, 8a, 9 lymph node dissection, 7. 5cm minilaparotomy, 8. Gastrectomy, 9 Roux-en Y reconstruction and HALS has not been used. Additionally, the anatomy of the blood vessels was evaluated preoperatively in detail using 3D-CT in 18 patients classified the Group 4.
Results) The mean operation time in the Group 4 (323 min) was significantly shorter than those of Gourp 1 (497 min), 2(459 min), 3 (456 min), respectively. There were no significant differences in the mean operation time between the Group 1, 2 and 3. The mean estimated blood loss in the Group 4 (96g) was significantly decreased compared with Group1 (545g) and Group 2 (502g). The mean estimated blood loss in the Group 3 (130g) was significantly decreased compared with Group1 and 2. The numbers of dissected lymph nodes in the Group 3 (29.8) and 4 (31.09) were significantly increased compared with Group 1 (14.9). The postoperative complications were one temporary anastomotic stenosis (Group 3) and two pancreatic fistula cured by conservative treatment (Gourp 3 and 4). There are no death resulted from progress of gastric cancer except for the patients with Stage IV.
Conclusion) The standardization of the procedure and the preoperative evaluation using 3D-CT were useful to improve the curability and the safety of the laparoscopy-assisted gastrectomy.
Program Number: P254