Authors: Daxing Xie Chaoran Yu Liang Liu Hasan Osaiweran Chun Gao Junbo Hu Jianping Gong
Publish Date: 2016/03/22
Volume: 30, Issue: 11, Pages: 5138-5139
Abstract
D2 lymphadenectomy has been widely accepted as a standard procedure of surgical treatment for local advanced gastric cancer 1 2 However neither the dissection boundary nor the extent of the excision for perigastric soft tissues has been described 3 4 5 6 7 Our previous researches demonstrate the existence of disseminated cancer cells in the mesogastrium 8 9 and present an understandable mesogastrium model for gastrectomy 10 Hence the D2 lymphadenectomy plus complete mesogastrium excision D2 + CME is firstly proposed in this study aiming to assess the safety feasibility and corresponding shortterm surgical outcomesAll of these patients underwent laparoscopy assisted D2 + CME radical gastrectomy with a curative R0 resection and all the operations were performed by Prof Jianping Gong chief of GI surgery of Tongji Hospital Huazhong University of Science and Technology All participants provided informed written consent to participate in the study This study was approved by the Tongji Hospital Ethics Committee The standard surgical procedures in the video are described as follows Dissect along the gastrocolic ligament and then toward the left colic flexture with special made gauze Bluntly separate the adipose tissues to find fascia plane Expose along the plane toward the splenic inferior polar area Precede to the origins of left gastroepiploic vessels LGEVs clip and cut All the mobilized adipose tissues in this area are defined as left gastroepiploic mesentery LGEM 10 Next turn to infrapyloric area Dissect the fascia plane between right gastroepiploic mesentery RGEM and transverse mesocolon Turn to the pancreas head remove the covering adipose tissues identify the superior mesentery vein and expose the origins of right gastroepiploic vessels RGEVs Clip and cut All the surrounding mobilized adipose tissues are defined as RGEM 10 Move to the superior boarder of pancreas with the stomach reflected cephalad incise the serosa and bluntly mobilize through the plane with gauze Turn to the common hepatic artery CHA remove the adherent adipose tissue Expose the root of left gastric vein clip and cut Dissect the thick sheath of left gastric artery expose at the root trip clip and cut All mobilized lateral adipose tissues and dorsal parts are defined as left gastric mesentery LGM 10 Toward right dissect follow the CHA and hepatic portal vein HPV Next move toward the left side of LGM and dissect along the splenic artery until reaching the posterior gastric wall Move to the anterior area of stomach and divide the lesser omentum Clean up the adipose tissue and nerves along the lesser curvature up to the gastroesophageal junction Expose and cut the right gastric vessels RGVs where the mobilized adipose tissues are defined as right gastric mesentery RGM 10 Reconstruction of the alimentary tract was done by extracorporeal anastomosis Standard recovery protocols were followed in postoperative treatmentsFiftyfour patients between September 2014 and March 2015 have been recruited with informed consent and underwent laparoscopic D2 + CME by a single surgeon The mean number of retrieved regional lymph nodes was 3504 ± 1070 range 14–55 The mean volume of blood loss was 1244 ± 2289 ml range 5–100 The mean laparoscopic surgery time was 12782 ± 1763 min range 110–165 The mean hospitalization time was 1109 ± 428 days range 8–28 No operative complication was observed during the hospitalizationThe anatomical boundary of mesogastrium is well described and dissected within D2 + CME surgical process It proves to be safely feasible and repeatable with less blood lost qualified lymph nodes retrieval results and other improved shortterm surgical outcomes in advanced gastric cancer Meanwhile potential disseminated cancer cells fall into the mesogastrium can be eradicated by D2 + CME
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