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Gastric Cancer

, Volume 12, Issue 2, pp 106–112 | Cite as

Left-sided approach for suprapancreatic lymph node dissection in laparoscopy-assisted distal gastrectomy without duodenal transection

  • Tetsu Fukunaga
  • Naoki Hiki
  • Masanori Tokunaga
  • Kyoko Nohara
  • Yoshimasa Akashi
  • Hiroshi Katayama
  • Hidemaro Yoshiba
  • Kazuhiko Yamada
  • Shigekazu Ohyama
  • Toshiharu Yamaguchi
Technical Note

Abstract

Laparoscopy-assisted distal gastrectomy (LADG) with extended lymph node dissection has not yet been widely adopted for the treatment of gastric cancers because of the perceived complexity of the procedure. Suprapancreatic lymph node dissection is one of the most important and demanding procedures in this approach. The techniques of duodenal transection within the abdominal cavity or taping of the common hepatic or splenic artery had traditionally been adopted for suprapancreatic nodal dissection during open surgery. In 2005, we developed a new laparoscopic procedure to safely and simply perform suprapancreatic lymph node dissection in LADG. We introduced a left-sided approach for the dissection of lymph nodes in the left gastropancreatic fold, where the body of the stomach is turned over and lifted ventrally to expose the left gastropancreatic fold through the opened lesser sac, without duodenal transection, and the suprapancreatic lymph nodes are resected en bloc in reverse order, i.e., including the lymph nodes along the proximal splenic artery (station 11p), around the celiac artery (station 9), and along the common hepatic artery (station 8a). Between April 2005 and December 2007, a total of 391 patients with cT1,2 gastric cancer underwent this surgical approach. In all patients, surgery was completed safely with favorable outcomes; mean operating time was 239 min and mean blood loss was 63 ml. The complication rate was 4.6% (18/391); there were ten conversions (2.6%) and no mortality. The aim of the present study was to describe the surgical technique of our new approach for LADG with extended lymph node dissection and to evaluate the treatment outcomes achieved by this technique.

Keywords

Gastric Cancer Splenic Artery Common Hepatic Artery Left Gastric Artery Hepatoduodenal Ligament 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Supplementary material, approximately 443 MB.

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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2009

Authors and Affiliations

  • Tetsu Fukunaga
    • 1
  • Naoki Hiki
    • 1
  • Masanori Tokunaga
    • 1
  • Kyoko Nohara
    • 1
  • Yoshimasa Akashi
    • 1
  • Hiroshi Katayama
    • 1
  • Hidemaro Yoshiba
    • 1
  • Kazuhiko Yamada
    • 1
  • Shigekazu Ohyama
    • 1
  • Toshiharu Yamaguchi
    • 1
  1. 1.Department of Gastroenterological Surgery, Gastroenterological CenterCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan

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