Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer

Abstract

the procedure, and reports the advantages of laparoscopic surgery by HALS for gastric cancer located in the upper portion of the stomach. Patients and operational methodsBetween March 1998 and March 2002, we had 170 cases of laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer located in the middle or lower third of the stomach. Of these, 104 patients were operated on by HALS and 66 by a totally laparoscopic procedure without HALS. Here, we report on laparoscopic resection by HALS for 28 patients with upper gastric carcinoma between March 1999 and March 2002. All the lesions for which endoscopic mucosal resection or partial gastrectomy were not indicated were thought to be limited to submucosa deep within the tumor, where no evidence of lymph node metastases had been found in preoperative examinations (cT1cN0) ( Table 1). The patients were divided into two groups according to the following criteria: (1) 16 patients (average age 61.4 years; range 40-84 years; male-female ratio 11 : 5) whose lesions were spread in both the upper and middle thirds of the stomach (UM cases) were given total gastrectomy with D2 dissection followed by Roux-en-Y reconstruction; (2) 12 patients (average age 67.6 years; range 48-83 years; male-female ratio 7 : 5) whose lesions were limited to the upper third of the stomach (U cases) were given proximal gastrectomy with D1 dissection followed by esophagogastrostomy, or D2 dissection followed by jejunal interposition. As a general rule, D1 dissection was performed for lesions where the invasion of the submucosa was slight (sm1), while D2 dissection was used for lesions which had massively invaded the submucosa (sm2).The surgeon's left hand was inserted into the peritoneal cavity thorough a transverse skin incision about Abstract Recently, a minimally invasive operation for gastric malignancies has been developed, and this laparoscopic operation is seen as a technique that will raise quality of life for patients. Previously, we reported this technique, as well as the results of a distal gastrectomy with regional lymph node dissection using hand-assisted laparoscopic surgery (HALS) for gastric cancer located in the middle or lower third of the stomach. This paper describes total or proximal gastrectomy with regional lymph node dissection by HALS on 28 cases of gastric cancer located in the upper portion of the stomach. After the mobilization of stomach and lymph node dissection via HALS, an anastomosis of the esophagus was performed intracorporeally with a conventional circular stapling device (PCEEA), whereas jejunojejunostomy and jejunogastrostomy were carried out extracorporeally with a conventional hand-sewn procedure through a HALS wound. The operation time and the amount of blood loss in all the patients were considered to be satisfactory, and the average number of dissected lymph nodes per patient was similar to that in open surgery. The patients had minimal morbidity and quick recovery after their operation. This technique was thought to be not only ...

Long‐term outcomes after laparoscopy‐assisted gastrectomy for advanced gastric cancer: Analysis of consecutive 106 experiences

“…Many authors have reported no major differences between LAG and ODG procedures in terms of the number of retrieved lymph nodes [3,4,11]. The mean number of retrieved lymph nodes was 34.3 AE 15.3 and this result did not show great difference from other reports [3,5,11,15]. To maintain a good operation field and avoid unnecessary manipulation or traction of the stomach during LAG procedure, smaller size of tumors might be more suitable according to our experience.…”

The initial experience of dual port laparoscopy-assisted total gastrectomy as a reduced port surgery for total gastrectomy

“…However, this would not be advantageous if the operation time was much longer or the amount of blood loss was much greater than those associated with C-LATG. The reported operation time, blood loss, and number of dissected lymph nodes in C-LATG were 187-304 min, 10-334 mL, and 26-48.5, respectively [21][22][23][24][25]. Our results for the operation time (253.0 ± 26.8 min), blood loss (33.4 ± 23.7 mL), and the number of dissected lymph nodes (31.6 ± 12.3) were within the ranges reported for C-LATG [21,22,25].…”

“…To make a definitive conclusion about this suggestion, an assessment of quality of life (including mental status) would be required. Furthermore, laparoscopic total gastrectomy is widely recognized as a less invasive surgery, but it is unknown whether RPS for total gastrectomy is less invasive than conventional laparoscopic gastrectomy [21][22][23][24][25]. Also, lately, procedures using 2 or 3 mm diameter forceps are gradually increasing in popularity for various surgeries.…”

Left-sided approach for suprapancreatic lymph node dissection in laparoscopy-assisted distal gastrectomy without duodenal transection

“…To perform reliable and safe extended lymph node dissection in LADG, efforts have focused on the replication of techniques established for open surgery, including duodenal transection and the taping of main arteries [2,3]. However, laparoscopic procedures replicating the procedures of open surgery tend to be technically diffi cult and time-consuming because of differences in the surgical environments, such as vision or space in the surgical fi eld [4][5][6].…”