Application value of vessel-guided lymph node dissection in the laparoscopic radical gastrectomy (D2) of distal gastric cancer

Abstract

Objective To investigate the application value of vessel-guided lymph node dissection (LND) in the laparoscopic distal gastrectomy (D2) of distal gastric cancer. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 157 patients who underwent laparoscopic distal gastrectomy (D2) of distal gastric cancer in the Affiliated Tumor Hospital of Shanxi Medical University from October 2012 to July 2015 were collected. Patients used vessel-guided LND that was divided into 4 steps: middle colic vessel-guided LND in the upper pyloric region, gastroduodenal artery-guided LND in the lower pyloric region, common hepatic artery-guided LND in the right upper margin of pancreas and splenic artery-guided LND in the left upper margin of pancreas. Observation indicators: (1) surgical and intraoperative situations, (2) postoperative pathological results, (3) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative 3-year survival rate up to June 2017. Measurement data with normal distribution were represented as ±s. The survival rate was calculated using the Kaplan-Meier method. Results (1) Surgical and intraoperative situations: 157 patients underwent successful laparoscopic distal gastrectomy (D2) of distal gastric cancer. Operation time, LND time, volume of intraoperative blood loss, time for initial out-of-bed activity, time to initial anal exsufflation and time of postoperative abdominal drainage-tube removal were (178±38)minutes, (61±27)minutes, (87±40)mL, (1.2±0.4)days, (2.8±1.3)days and (7.5±2.6)days, respectively. Of 157 patients, 10 with postoperative complications were improved by conservative treatment, including 5 with intestinal obstruction, 3 with anastomotic fistula and 2 dying of pulmonary infection; other patients didn′t have complications. Duration of hospital stay of 157 patients was (9±3)days. (2) Postoperative pathological results: total number of LND, numbers of LND in the lower pyloric region and in the upper margin of pancreas were 34.6±11.0, 4.8±2.1 and 12.3±4.7, respectively. TNM staging: 26, 33, 18, 24, 37 and 19 patients were respectively detected in stageⅠa, Ⅰb, Ⅱa, Ⅱb, Ⅲa and Ⅲb. (3) Follow-up situations: 142 of 157 patients were followed up for 6-56 months, with a median time of 27 months, and postoperative 3-year survival rate was 67.6%. Conclusion The vessel-guided LND is safe and effective in the laparoscopic distal gastrectomy (D2) of distal gastric cancer, and the operation steps can be simplified. Key words: Gastric neoplasms; Gastrectomy; Lymph node dissection; Vessel-guided; Laparoscopy