Clockwise, Modularized Lymphadenectomy in Laparoscopic Gastric Cancer Surgery: a New Laparoscopic Surgery Model
- 95 Downloads
The aim of the study is to present the clockwise, modularized lymphadenectomy model of laparoscopic gastrectomy for gastric cancer patients, which is based on our clinical practice experience in laparoscopic gastric cancer surgery.
From Jan 2015 to July 2017, 116 patients who underwent laparoscopic gastrectomy were retrospectively collected and analyzed. According to the different resection models, patients were divided into two groups: traditional laparoscopic lymphadenectomy group (63 patients) and clockwise, modularized lymphadenectomy group (53 patients). Operation-related parameters were compared between the two groups.
The clockwise, modularized lymphadenectomy group had less dissection time (119.8 ± 19.1 min vs. 135.3 ± 23.8 min, p < 0.001) and less intraoperative blood loss (81.7 ± 42.9 ml vs. 91.4 ± 28.7 ml, p = 0.016) compared with the traditional laparoscopic lymphadenectomy group. Meanwhile, the clockwise, modularized lymphadenectomy group had more numbers of examined lymph nodes (40.5 ± 14.3 vs. 33.9 ± 11.0, p = 0.007) than the traditional laparoscopic lymphadenectomy group. Besides, there was no statistically significant difference in the postoperative complication rates between the two groups. The clockwise, modularized lymphadenectomy group had shorter postoperative hospital stay than the traditional laparoscopic lymphadenectomy group (8.7 ± 3.2 days vs. 10.4 ± 3.9 days, respectively, p < 0.001).
Through the adoption of the fixed sequence of lymphadenectomy, requirements and standard of lymphadenectomy of each lymph node station, and specific surgical skills for intraoperative exposure by the clockwise and modularized lymphadenectomy model, we can optimize and facilitate the laparoscopic gastric cancer surgery.
KeywordsGastric cancer Lymphadenectomy Laparoscopy Surgery
Traditional laparoscopic lymphadenectomy
Clockwise, modularized lymphadenectomy
Body mass index
Left gastroepiploic vein
Inferior spleen vein
Right gastroepiploic vein
Anterior superior pancreaticoduodenal vein
Accessory right colic vein
- RGA CHA
Common hepatic artery
Left gastric artery
Left gastric vein
The authors thank the substantial work of the Volunteer Team of Gastric Cancer Surgery (VOLTGA) based on the Multidisciplinary Team (MDT) of Gastrointestinal Tumors, West China Hospital, Sichuan University, China.
1) The National Natural Science Foundation of China (No. 81372344).
2) Sichuan Province Youth Science & Technology Innovative Research Team, No. 2015TD0009.
3) 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University, No. ZY2017304.
4) Fund for Fostering Academic and Technical Leaders of Sichuan Province, No.  183-19.
Wei-Han Zhang, Kun Yang, and Jian-Kun Hu designed the study;
Wei-Han Zhang, Kun Yang, Kai Liu, and Wei-Wei Wu collected the clinical information;
Wei-Han Zhang, Kun Yang, Xin-Zu Chen, Zong-Guang Zhou, and Jian-Kun Hu analyzed and interpreted the data;
Wei-Han Zhang, Xin-Zu Chen, and Ying-Zhao conducted the statistical analysis;
Wei-Han Zhang, Wei-Wei Wu, and Jian-Kun Hu edited the surgical video.
Jian-Kun Hu and Zong-Guang Zhou supervised this study;
All authors contributed to the writing of the manuscript and final approval.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
- 4.Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2016.Google Scholar
- 5.Katai H, Mizusawa J, Katayama H, et al. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2017;20(4):699–708.CrossRefGoogle Scholar
- 6.Hiki N, Katai H, Mizusawa J, et al. Long-term outcomes of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG0703). Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2017.Google Scholar
- 8.Hu Y, Huang C, Sun Y, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2016;34(12):1350–1357.CrossRefGoogle Scholar
- 12.Inokuchi M, Nakagawa M, Tanioka T, Okuno K, Gokita K, Kojima K. Long- and short-term outcomes of laparoscopic gastrectomy versus open gastrectomy in patients with clinically and pathological locally advanced gastric cancer: a propensity-score matching analysis. Surgical endoscopy. 2017.Google Scholar
- 15.Hu J, Yang K, Chen X, et al. [Application of clockwise modularized lymphadenectomy in laparoscopic gastrectomy for gastric cancer]. Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery. 2017;20(2):200–206.Google Scholar
- 19.Diaz-Gonzalez A, Monclus E, Darnell A, Sole M, Bruix J. Liver metastases from gastric adenocarcinoma mimicking multinodular hepatocellular carcinoma. Hepatology. 2018.Google Scholar
- 24.Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2004;22(11):2069–2077.CrossRefGoogle Scholar
- 28.Misawa K, Fujiwara M, Ando M, et al. Long-term quality of life after laparoscopic distal gastrectomy for early gastric cancer: results of a prospective multi-institutional comparative trial. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2015;18(2):417–425.CrossRefGoogle Scholar
- 29.Wada N, Kurokawa Y, Takiguchi S, et al. Feasibility of laparoscopy-assisted total gastrectomy in patients with clinical stage I gastric cancer. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2014;17(1):137–140.CrossRefGoogle Scholar