Application of clockwise modularized laparoscopic lymphadenectomy in the suprapancreatic area, a propensity score matching study and comparison with open gastrectomy

Yang, Hua; Zhang, Weihan; Li, Kai; Dan, Yuqing; Chen, Xin-Zu; Yang, Kun; Chen, Zhuo; Chen, Jiaping; Zhou, Zong‐Guang; Hu, Jian-Kun

doi:10.1007/s00464-020-08070-w

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…This is an outstanding technique to prevent injury of pancreas and splenic vessels. Furthermore, the sequence of clockwise and modularized lymphadenectomy could ensure a monodirectional operation, and the former step prepared the manipulative room and scope for the next step until all the procedures were finished [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

The Safety and Feasibility of Laparoscopic Gastrectomy after Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

Zhang

et al. 2022

Journal of Oncology

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Background. Neoadjuvant chemotherapy is incrementally applied to remedy locally advanced gastric cancer. However, NACT also enhances the difficulty of laparoscopic lymph node dissection. The objective of our study was to evaluate the safety and feasibility of laparoscopic gastrectomy for locally advanced gastric cancer after neoadjuvant chemotherapy. Methods. From July 2017 to December 2019, 153 patients who received neoadjuvant chemotherapy and underwent the subsequent surgical procedure were retrospectively enrolled and analyzed in the Gastrointestinal Surgery Department of West China Hospital. According to surgical methods, all the patients were sectionalized into two groups: laparoscopic assistant gastrectomy (LAG, 77 patients) and traditional open gastrectomy (OG, 76 patients). The demographic parameters, preoperative, surgical, pathological, and neoadjuvant chemotherapy features were compared between the two groups. Results. A total of 153 patients accepted neoadjuvant chemotherapy and surgical resection in our study. There was no statistically significant difference in demographic parameters and preoperative and neoadjuvant chemotherapy characteristics between the two groups. The LAG group illustrated less intraoperative blood loss (91.1 ± 53.1 ml vs. 125.7 ± 116.9 ml, p = 0.010 ) and shorter postoperative hospital stays (7.9 ± 2.1 days vs. 125.7 ± 116.9 days, p = 0.009 ), when compared to the OG group. Moreover, there was no disparity with respect to operative duration, number of harvested lymph nodes, and postoperative complication rates between the two groups. When considering the Clavien–Dindo classification, no statistically significant difference was indicated in all stratifications with regard to postoperative complications. Conclusion. Laparoscopic gastrectomy for locally advanced gastric cancer after neoadjuvant chemotherapy is safe and feasible without increasing postoperative adverse events.

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Section: Discussionmentioning

confidence: 99%

The Safety and Feasibility of Laparoscopic Gastrectomy after Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

Zhang

et al. 2022

Journal of Oncology

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“…In radical gastric cancer surgery, laparoscopic surgery faces two major problems ( 7 , 8 ). The first problem is related to the specificity of the structure of the gastric anatomy itself; the complex and varied perigastric vascular anatomy requires higher levels of surgical design, and an extensive LND.…”

Section: Introductionmentioning

confidence: 99%

The “quadrant-sandwich” method in clockwise modular D2 lymph node dissection in laparoscopic total gastrectomy: a retrospective cohort study

Cao,

Zhang,

et al. 2024

J Gastrointest Oncol

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Background For patients who need laparoscopic radical gastrectomy, lymph node dissection (LND) and optimization of surgical procedures are particularly important. This study introduces the “quadrant-sandwich” method in clockwise modular D2 LND and evaluates the advantages and safety of this method. Methods The clinical data of 108 laparoscopic total gastrectomy patients admitted to the Affiliated Cancer Hospital of Zhengzhou University from January 2019 to January 2022 were retrospectively analyzed. Based on the different LND processes, 55 patients were allocated to the observation group, which underwent clockwise modular LND using the “quadrant-sandwich method”, and 53 patients were allocated to the control group, which underwent traditional LND. The effectiveness and safety of the approach in terms of operation time, blood loss, lymph node yield, postoperative recovery and postoperative complications were observed in the two groups. Results There was no statistical difference between the baseline data of the two groups. In relation to the surgery, the observation group had an operation time of 227.0±48.5 minutes, and intraoperative bleeding of 100.0 mL [inter-quartile range (IQR), 30.0–200.0 mL], while the control group had an operation time of 247±41.5 minutes, and intraoperative bleeding of 180.0 mL (IQR, 130.0–245.0 mL). There were statistically significant differences between the two groups in terms of the operation time and intraoperative bleeding (P=0.001, P=0.020). In relation to the LND, there were no statistically significant differences between the two groups in terms of the total number of lymph nodes in each division, and the number of positive lymph nodes. In relation to the post-operative results, there were no statistically significant differences between the two groups in terms of the post-operative pathological stage, first postoperative oral feeding, post-operative hospitalization time, and post-operative complications. Conclusions Clockwise modular D2 LND using the “quadrant-sandwich method” is potentially safe and feasible in laparoscopic total gastrectomy. It not only ensures the thoroughness of the LND, but also ensures and efficient and fast surgical process, shortens the operation time, and reduces the amount of intraoperative bleeding.

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”Straight-line modular” operation mode of upper pancreatic lymph-node dissection in laparoscopic radical resection of proximal gastric cancer (with Video)

Li¹,

Zhang²,

Li³

et al. 2022

Asian Journal of Surgery

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Application of clockwise modularized laparoscopic lymphadenectomy in the suprapancreatic area, a propensity score matching study and comparison with open gastrectomy

Cited by 3 publications

References 29 publications

The Safety and Feasibility of Laparoscopic Gastrectomy after Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

The Safety and Feasibility of Laparoscopic Gastrectomy after Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

The “quadrant-sandwich” method in clockwise modular D2 lymph node dissection in laparoscopic total gastrectomy: a retrospective cohort study

”Straight-line modular” operation mode of upper pancreatic lymph-node dissection in laparoscopic radical resection of proximal gastric cancer (with Video)

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