Advertisement

Laparoscopic Suprapancreatic Lymph Node Dissection for Advanced Gastric Cancer Using a Left-Sided Approach

  • 593 Accesses

  • 11 Citations

Abstract

Background

We developed a novel procedure for laparoscopic suprapancreatic lymph node (LN) dissection, which is compulsory and quite difficult for patients with advanced gastric cancer.1 3

Methods

We dissected suprapancreatic LNs from the left to the right side. The No. 11p LNs were dissected first, followed by the No. 9, 7, and 8a LNs. Dissection of the No. 5 and 12a LNs was completed last. The above procedure was performed on 814 consecutive patients with stage cT2–3 disease.

Results

Mean operation time was 186.9 ± 56.4 min (range 80–480 min), mean blood loss was 76.6 ± 106.8 ml (range 3–500 ml), and mean times to first flatus, fluid diet, and soft diet were 3.7 ± 1.2 days (range 1–9 days), 5.2 ± 1.7 days (range 2–14 days), and 8.3 ± 2.2 days (range 5–20 days), respectively. A mean 34.5 ± 12.9 LNs (range 22–103) were retrieved, including a mean 12.4 ± 5.7 (range 0–35) suprapancreatic area LNs. Overall postoperative morbidity rate was 14.7 % (120/814), including three cases of pancreatic fistula. All of these postoperative complications were successfully treated by conservative methods. At a median follow-up of 27 months (range 1–63), cumulative 3-year overall survival was 59.2 %.

Conclusion

Laparoscopic suprapancreatic LN dissection using a left-sided approach could be safely achieved and is more convenient for advanced gastric cancer.

References

  1. 1.

    Shinohara T, Hanyu N, Kawano S, et al. Clinical significance of medial approach for suprapancreatic lymph node dissection during laparoscopic gastric cancer surgery. Surg Endosc. 2014;28(5): 1678–1685.

  2. 2.

    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14: 113–123.

  3. 3.

    Ryu KW, Kim YW, Lee JH, Nam BH, Kook MC, Choi IJ, et al. Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol. 2008;15:1625–1631.

  4. 4.

    Fukunaga T, Hiki N, Tokunaga M, Nohara K, Akashi Y, Katayama H, et al. Left-sided approach for suprapancreatic lymph node dissection in laparoscopy-assisted distal gastrectomy without duodenal transection. Gastric Cancer. 2009;12(2):106–112.

Download references

Acknowledgment

Sponsored by the National Key Clinical Specialty Discipline Construction Program of China (No. [2012]649), and the Key Project of Science and Technology Plan of Fujian Province, China (Grant No. 2014Y0025).

Author information

Correspondence to Chang-Ming Huang MD.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MPG 199560 kb)

Supplementary material 1 (MPG 199560 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Huang, C., Chen, Q., Lin, J. et al. Laparoscopic Suprapancreatic Lymph Node Dissection for Advanced Gastric Cancer Using a Left-Sided Approach. Ann Surg Oncol 22, 2351 (2015) doi:10.1245/s10434-014-4309-y

Download citation

Keywords

  • Gastric Cancer
  • Early Gastric Cancer
  • Advanced Gastric Cancer
  • Soft Diet
  • Gastric Cancer Surgery