Total Gastrectomy with D2 Lymph Node Dissection

Abstract

The recent results of the randomized controlled trial comparing total gastrectomy (TG) with and without splenectomy demonstrated lower morbidity and similar survival in the spleen preservation group in comparison to the splenectomy group. Therefore, spleen-preserving TG either with or without a #10 lymphadenectomy is now considered to be the standard surgery for upper advanced gastric cancer. Dissection along the splenic artery and its branches is a complicated and difficult procedure. Robotic gastrectomy (RG) should be advantageous in more complicated surgeries, such as advanced upper gastric cancer requiring TG. One of the expected benefits of robotic TG is to decrease the postoperative morbidity, especially the pancreas-related complications, because direct contact of the dissection device with the pancreas can be avoided by using articulated devices. There are a limited number of studies evaluating robotic TG for advanced gastric cancer. However, a comparative study showed the feasibility of robotic TG and demonstrated retrieval of a greater number of lymph nodes along the splenic artery and the splenic hilum in comparison with laparoscopic TG. This subchapter will focus on the technical aspects of robotic TG with D2 lymph node dissection and describe the setup, patient positioning, and surgical techniques of TG, especially those employed for the lymph node dissection around the splenic hilum and the supra-pancreatic area.