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Annals of Surgical Oncology

, Volume 23, Issue 3, pp 951–951 | Cite as

Laparoscopic Infrapyloric Area Lymph Node Dissection with No. 14v Enlargement for Advanced Lower Gastric Cancer in Middle Colic Vein Approach

  • Qi-Yue Chen
  • Chang-Ming Huang
  • Jian-Xian Lin
  • Chao-Hui Zheng
  • Ping Li
  • Jian-Wei Xie
  • Jia-Bin Wang
  • Jun Lu
  • Xin-Tao Yang
Gastrointestinal Oncology

Abstract

Background

We developed a procedure for laparoscopic infrapyloric area lymph node (LN) dissection with No. 14v enlargement, which is complicated for patients with advanced lower gastric cancer (GC) (Xu et al., World J Gastroenterol 13:5133–5138,2007; Masuda et al., Dig Surg 25:351–358,2008; An et al., Br J Surg 98:667–672,2011].

Methods

From April 2008 to December 2014, 1096 patients with GC underwent laparoscopy-assisted radical distal gastrectomy in our department. According to the Japanese GC treatment guidelines, D2 (+No. 14v) may be beneficial in tumors with apparent metastasis to the No. 6 nodes (Japanese Gastric Cancer Association, Gastric Cancer 14:113–123,2010). Thus, 151 advanced lower GC patients with apparent metastasis to the No. 6 nodes underwent additional No. 14v LN dissection.␣We dissected infrapyloric area LNs with No. 14v dissection from the left to the right side (i.e., middle colic vein approach).

Results

Mean operation time was 22.8 ± 10.0 min, mean blood loss was 17.1 ± 14.6 ml, and mean times to first flatus, fluid diet, and soft diet were 3.7 ± 1.2 days, 5.0 ± 1.7 days, and 8.4 ± 1.6 days, respectively. A mean of 33.7 ± 11.2 LNs were retrieved, including 3.9 ± 2.7 No. 6 LNs and 2.0 ± 1.6 No. 14v LNs. Of 151 patients, 26 had No. 14v metastasis (17.2 %), and 43 (28.5 %) were accompanied by an extensive infrapyloric area nodal involvement. The overall postoperative morbidity rate was 10.6 % (16 of 151). At a median follow-up of 56 months (range 5–84 months), cumulative 3-year overall survival was 56.0 %.

Conclusions

Although it remains controversial whether prophylactic No. 14v dissection improves survival, laparoscopic infrapyloric area LN dissection using a middle colic vein approach may be safely achieved and is more convenient for advanced lower GC.

Keywords

Gastric Cancer Lymph Node Dissection Early Gastric Cancer Superior Mesenteric Vein Soft Diet 
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.

Notes

Acknowledgments

Sponsored by National Key Clinical Specialty Discipline Construction program of China (grant [2012]649) and the Key Project of Science and Technology Plan of Fujian Province, China (Grant 2014Y0025).

Disclosure

The authors declare no conflict of interest.

Supplementary material

10434_2015_4992_MOESM1_ESM.mpg (276.5 mb)
Supplementary material 1 (MPG 283130 kb)

References

  1. 1.
    Xu YY, Huang BJ, Sun Z, et al. Risk factors for lymph node metastasis and evaluation of reasonable surgery for early gastric cancer. World J Gastroenterol. 2007;13:5133–8.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Masuda TA, Sakaguchi Y, Toh Y, et al. Clinical characteristics of gastric cancer with metastasis to the lymph node along the superior mesenteric vein (14v). Dig Surg. 2008;25:351–8.CrossRefPubMedGoogle Scholar
  3. 3.
    An JY, Pak KH, Inaba K, et al. Relevance of lymph node metastasis along the superior mesenteric vein in gastric cancer. Br J Surg. 2011;98:667–72.CrossRefPubMedGoogle Scholar
  4. 4.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines, 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Qi-Yue Chen
    • 1
  • Chang-Ming Huang
    • 1
  • Jian-Xian Lin
    • 1
  • Chao-Hui Zheng
    • 1
  • Ping Li
    • 1
  • Jian-Wei Xie
    • 1
  • Jia-Bin Wang
    • 1
  • Jun Lu
    • 1
  • Xin-Tao Yang
    • 1
  1. 1.Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina

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