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

Comparative study of laparoscopicvsopen gastrectomy in gastric cancer management

“…However it has to be said that many case series have been recently published showing adequate resection margins and lymph nodes retrieval for LGS in AGC whilst long term results still lack of comfortable numbers [13][14][15][16] .…”

What technique is suitable for laparoscopic suprapancreatic lymph node dissection?

“…In laparoscopic suprapancreatic lymph node dissection, better methods are required for improving the operative fi eld and handling the lymph node dissection. In their article, Fukunaga et al [5] emphasize that not transecting the duodenum inside the abdominal cavity is useful for obtaining a clear view of the operative fi eld during LADG.…”

“…The new technique by Fukunaga et al [5] is described as an expansion of the hepatoduodenal ligament and the left gastropancreatic fold without transection of the duodenum, which achieves an improved fi eld of view. Fukunaga et al [5] show that for 12a lymph node dissection, the hepatoduodenal ligament can be expanded easily by pulling strongly on the pyloric region of the stomach in the left caudal direction owing to omission of duodenal transection. Also, the authors demonstrate that for No.…”

“…Therefore, it is necessary to establish safe techniques of suprapancreatic lymph node dissection in LADG with D2 or D2 modifi ed lymph node dissection. The new technique of a left-sided approach to suprapancreatic lymph node dissection introduced in the article by Fukunaga et al in this issue [5] may be useful for complete suprapancreatic lymph node dissection.…”

Ongoing clinical studies of minimally invasive surgery for gastric cancer in Japan

“…In Asian countries, D2 lymph node dissection is routinely carried out in AGC, the main advantages of D2 lymph node dissection being considered to include prolonged survival and improved staging accuracy (24,25). Techniques for D2 lymph node dissection were recently developed for laparoscopic surgery and used in several Asian institutions (5,26,27). Recent retrospective studies and meta-analysis comparing laparoscopic D2 gastrectomy and open D2 gastrectomy for AGC demonstrated that the laparoscopic procedure may be feasible (11)(12)(13)17).…”