Abstract
BackgroundGastric cancer is one of the most common malignancies and is a leading cause of cancer death worldwide. Surgery is the most effective and successful method of treatment for gastric cancer, and systematic lymph node (LN) dissection is unquestionably the most effective procedure for treating LN metastases of gastric cancer. Systematic lymphadenectomy is the most important part of curative resection, but lymphadenectomy is also the most difficult procedure in gastric cancer surgery. The aim of this study is to report our three-step method for lymphadenectomy in gastric cancer.MethodsIn this study, the lymph node stations and groups were defined according to the 13th edition of the Japanese Classification for Gastric Carcinoma. The authors’ novel, simplified method consists of three steps: (1) the Kocher maneuver and dissection of the greater omentum together with the anterior sheet of the mesocolon, (2) dissection of the lesser omentum, and (3) lymphadenectomy following the main vessels. We primarily used Peng’s multifunctional operative dissector, which combines four different functions (cutting, separating, aspirating and coagulating). Our systematic lymphadenectomy included three steps, and the main procedure started from right to left and in the caudal to cranial direction.ResultsA total of 830 consecutive patients underwent our three-step-method systematic lymphadenectomy in advanced gastric cancer surgery. The mean operation time was 146 minutes, and the mean blood loss was 248 ml. The median postoperative hospital stay was 10.9 ± 4.8 days. The median number of examined LN was 31.6 (range 17 to 72) per patient, and the median number of metastatic LN was 5.6 (range 0 to 42) per patient. The overall incidence of postoperative complications was 10.6%, and the rate of hospital death was 0.9%. The overall three-year survival rate was 52.6%.ConclusionsOur three-step method for lymphadenectomy is easy to perform and is a useful procedure for gastric cancer surgery.
Highlights
Gastric cancer is one of the most common malignancies and is a leading cause of cancer death worldwide
The complex lymph node (LN) of the stomach have been organized by a useful classification system described in the Japanese Classification for Gastric Carcinoma (JCGC) [1]
The purpose of this study is to introduce a novel procedure for safe and simple lymphadenectomy in gastric cancer surgery
Summary
Gastric cancer is one of the most common malignancies and is a leading cause of cancer death worldwide. Surgery is the most effective and successful method of treatment for gastric cancer, and systematic lymph node (LN) dissection is unquestionably the most effective procedure for treating LN metastases of gastric cancer. The JCGC staging system was designed to describe the anatomic locations of the nodes removed during gastrectomy. According to this classification system, 16 different LN stations surrounding the stomach were identified (Figure 1). Our three-step method for lymphadenectomy routinely removes all above mentioned nodes except the paraaortic node (station number 16); the details regarding which node groups should be removed in different patients depend on the site of the tumor and the level of dissection required [2]
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