Short-term outcomes of laparoscopic D2 lymphadenectomy with complete mesogastrium excision for advanced gastric cancer

Abstract

The 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 short-term surgical outcomes in advanced gastric cancer. Meanwhile, potential disseminated cancer cells fall into the mesogastrium can be eradicated by D2 + CME.

Laparoscopic D2 plus complete mesogastrium excision using the "enjoyable space" approach versus conventional D2 total gastrectomy for local advanced gastric cancer: short-term outcomes.

“…However, there is another less common procedure to treat gastric cancer. Although some surgeons have attempted D2 + complete mesogastrium excision (CME) or total gastrectomy through the outside bursa, the standard surgical plane and technique for CME are still unclear [11,12]. In contrast to the free part of the stomach, the posterior part of the stomach is composed of complex anatomical structures, including multiple fascias of the perigastric mesogastrium, intricate vascular networks and peripheral organs.…”

Detection of carcinoembryonic antigen in peritoneal fluid of patients undergoing laparoscopic distal gastrectomy with complete mesogastric excision

“…In contrast, D2 + CME was associated with a lower rate of high CEA expression in the peritoneal fluid (15 per cent) and better DFS. A previous study found that mean(s.d.) intraoperative bleeding was 12·44(22·89) ml and duration of hospital stay was 11·09(4·28) days in patients undergoing laparoscopic distal gastrectomy with CME.…”

Prospective randomized controlled trial to compare laparoscopic distal gastrectomy (D2 lymphadenectomy plus complete mesogastrium excision, D2 + CME) with conventional D2 lymphadenectomy for locally advanced gastric adenocarcinoma: study protocol for a randomized controlled trial

“…Patients in the D2 + CME group receive standardized LADG with D2 + CME [ 15 ], which is performed by the founder of this procedure. The standard D2 + CME procedure should meet the following criteria: Clearly exposing five mesogastrium (left gastroepiploic mesentery, right gastroepiploic mesentery, left gastric mesentery, right gastric mesentery, and postgastric mesentery) En bloc separation of the mesentery from the mesenteric bed Dissecting along the root of the mesentery Ligation should reach the root of the blood vessels.…”

“…Our previous studies have demonstrated the existence of disseminated cancer cells (named metastasis V) in the mesogastrium [ 12 , 13 ] that presented an understandable mesogastrium model for gastrectomy [ 14 ]. Therefore, we put forward D2 lymphadenectomy plus complete mesogastrium excision (D2 + CME) to resect both the primary lesion and adjacent tissue as completely as possible to avoid residual tumor or cancer cell spreading [ 15 ]. Although a retrospective study has shown that D2 + CME exhibited advantages in intraoperative hemorrhage and postoperative recovery course [ 15 ], there is still no prospective randomized controlled trial assessing its therapeutic effect.…”

“…Therefore, we put forward D2 lymphadenectomy plus complete mesogastrium excision (D2 + CME) to resect both the primary lesion and adjacent tissue as completely as possible to avoid residual tumor or cancer cell spreading [ 15 ]. Although a retrospective study has shown that D2 + CME exhibited advantages in intraoperative hemorrhage and postoperative recovery course [ 15 ], there is still no prospective randomized controlled trial assessing its therapeutic effect. To further evaluate the D2 + CME procedure, we initiated this single-center, prospective, randomized controlled trial to compare disease-free survival (DFS), overall survival (OS), recurrence, mortality, morbidity, postoperative recovery course, and other parameters between D2 + CME and the conventional D2 procedure in patients with locally advanced gastric cancer who underwent laparoscopic distal gastrectomy.…”