Abstract
Background
We developed a procedure for laparoscopic infrapyloric area lymph node (LN) dissection with No. 14v enlargement, which is complicated for patients with advanced lower gastric cancer (GC) (Xu et al., World J Gastroenterol 13:5133–5138,2007; Masuda et al., Dig Surg 25:351–358,2008; An et al., Br J Surg 98:667–672,2011].
Methods
From April 2008 to December 2014, 1096 patients with GC underwent laparoscopy-assisted radical distal gastrectomy in our department. According to the Japanese GC treatment guidelines, D2 (+No. 14v) may be beneficial in tumors with apparent metastasis to the No. 6 nodes (Japanese Gastric Cancer Association, Gastric Cancer 14:113–123,2010). Thus, 151 advanced lower GC patients with apparent metastasis to the No. 6 nodes underwent additional No. 14v LN dissection.␣We dissected infrapyloric area LNs with No. 14v dissection from the left to the right side (i.e., middle colic vein approach).
Results
Mean operation time was 22.8 ± 10.0 min, mean blood loss was 17.1 ± 14.6 ml, and mean times to first flatus, fluid diet, and soft diet were 3.7 ± 1.2 days, 5.0 ± 1.7 days, and 8.4 ± 1.6 days, respectively. A mean of 33.7 ± 11.2 LNs were retrieved, including 3.9 ± 2.7 No. 6 LNs and 2.0 ± 1.6 No. 14v LNs. Of 151 patients, 26 had No. 14v metastasis (17.2 %), and 43 (28.5 %) were accompanied by an extensive infrapyloric area nodal involvement. The overall postoperative morbidity rate was 10.6 % (16 of 151). At a median follow-up of 56 months (range 5–84 months), cumulative 3-year overall survival was 56.0 %.
Conclusions
Although it remains controversial whether prophylactic No. 14v dissection improves survival, laparoscopic infrapyloric area LN dissection using a middle colic vein approach may be safely achieved and is more convenient for advanced lower GC.
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References
Xu YY, Huang BJ, Sun Z, et al. Risk factors for lymph node metastasis and evaluation of reasonable surgery for early gastric cancer. World J Gastroenterol. 2007;13:5133–8.
Masuda TA, Sakaguchi Y, Toh Y, et al. Clinical characteristics of gastric cancer with metastasis to the lymph node along the superior mesenteric vein (14v). Dig Surg. 2008;25:351–8.
An JY, Pak KH, Inaba K, et al. Relevance of lymph node metastasis along the superior mesenteric vein in gastric cancer. Br J Surg. 2011;98:667–72.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines, 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.
Acknowledgments
Sponsored by National Key Clinical Specialty Discipline Construction program of China (grant [2012]649) and the Key Project of Science and Technology Plan of Fujian Province, China (Grant 2014Y0025).
Disclosure
The authors declare no conflict of interest.
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Chen, QY., Huang, CM., Lin, JX. et al. Laparoscopic Infrapyloric Area Lymph Node Dissection with No. 14v Enlargement for Advanced Lower Gastric Cancer in Middle Colic Vein Approach. Ann Surg Oncol 23, 951 (2016). https://doi.org/10.1245/s10434-015-4992-3
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DOI: https://doi.org/10.1245/s10434-015-4992-3