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Surgical technique of suprapancreatic D2 lymphadenectomy focusing on the posterior hepatic plexus for advanced gastric cancer

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Abstract

Purpose

Although D2 lymphadenectomy is currently considered a standard procedure for advanced gastric cancer (GC) worldwide, there is room for discussion about the appropriate range of suprapancreatic D2 lymphadenectomy. Focusing on the posterior hepatic plexus (PHP), which is not well recognized, we developed a surgical technique of suprapancreatic D2 lymphadenectomy, which we have called PHP-D2, and its short-term and long-term efficacies were evaluated in comparison with non-PHP-D2.

Methods

GC patients who underwent distal gastrectomy with D2 lymphadenectomy between July 2006 and May 2013 were enrolled, from which patients who had peritoneal metastasis and/or were peritoneal cytology-positive during surgery were excluded. Their medical records were retrospectively reviewed.

Results

Ninety-two patients (non-PHP-D2: 48, PHP-D2: 44) were enrolled. Shorter operation time (330 min vs 275 min, p < 0.0001) and less blood loss (290 mL vs 125 mL, p < 0.0001) were observed in PHP-D2, and no pancreatic fistulas were observed in PHP-D2. More lymph nodes of #11p (1 vs 1.5, p = 0.0328) and #12a lymph nodes (0 vs 1, p = 0.0034) were retrieved in PHP-D2, with no significant differences in #8a and #9 lymph nodes. Lymphatic recurrence was significantly less in PHP-D2 (p = 0.0166), and univariate and multivariate analyses showed that non-PHP-D2 was a significant risk factor for lymphatic recurrence (p = 0.0158), although there were no significant differences between non-PHP-D2 and PHP-D2 in 5-year overall survival and 5-year relapse-free survival.

Conclusion

PHP-D2 was a safe and feasible procedure that had the potential to reduce lymphatic recurrence, and it can be a standard procedure of D2 lymphadenectomy for advanced GC.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan

    Nobuhiko Kanaya, Shinji Kuroda, Yoshihiko Kakiuchi, Sho Takeda, Satoru Kikuchi, Kazuhiro Noma, Ryuichi Yoshida, Yuzo Umeda, Fuminori Teraishi, Masahiko Nishizaki, Shunsuke Kagawa & Toshiyoshi Fujiwara

  2. Minimally Invasive Therapy Center, Okayama University Hospital, Okayama, Japan

    Satoru Kikuchi & Shunsuke Kagawa

Authors
  1. Nobuhiko Kanaya
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  2. Shinji Kuroda
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  3. Yoshihiko Kakiuchi
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  4. Sho Takeda
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  5. Satoru Kikuchi
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  6. Kazuhiro Noma
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  7. Ryuichi Yoshida
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  8. Yuzo Umeda
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  9. Fuminori Teraishi
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  11. Shunsuke Kagawa
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  12. Toshiyoshi Fujiwara
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Contributions

Study conception and design: SK.

Acquisition of data: NK and SK.

Analysis and interpretation of data: NK, SK, YK, and ST.

Drafting of manuscript: NK and SK.

Critical revision of manuscript: SK, KN, YU, RY, FT, MN, SK, and TF

Corresponding author

Correspondence to Shinji Kuroda.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate

The IRB waived the requirement to obtain informed consent from the patients for this study because of the retrospective nature of the study.

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The authors declare no competing interests.

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Kanaya, N., Kuroda, S., Kakiuchi, Y. et al. Surgical technique of suprapancreatic D2 lymphadenectomy focusing on the posterior hepatic plexus for advanced gastric cancer. Langenbecks Arch Surg 407, 871–877 (2022). https://doi.org/10.1007/s00423-022-02437-4

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  • DOI: https://doi.org/10.1007/s00423-022-02437-4

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