Vagus Nerve-preserving Gastrectomy Research Articles

Performing robot-assisted pylorus and vagus nerve-preserving gastrectomy for early gastric cancer: A case series of initial experience.

Pylorus and vagus nerve-preserving gastrectomy (PPG) is a function-preserving surgery for early gastric cancer (GC) that has gained considerable interest in the recent years. The operative technique performed using the Da Vinci Xi robot system is considered ideal for open and laparoscopic surgery. To introduce Da Vinci Xi robot-assisted PPG (RAPPG)-based operative procedure and technical points as well as report the initial experience based on the clinical pathology data of eight cases of early GC. Da Vinci Xi robot-assisted pylorus and vagus nerve-preserving gastrectomy (RAPPG) was performed for 11 consecutive patients with middle GC from December 2020 to July 2021. Outcome measures were postoperative morbidity, operative time, blood loss, number of lymph nodes harvested, postoperative hospital stay, time to first flatus, time to diet, and resection margins. Eight of the 11 patients who were pathologically diagnosed with early GC were enrolled in a retrospective study to assess the feasibility and safety of RAPPG. The mean operative time, mean blood loss, mean number of lymph nodes harvested, length of preserved pylorus canal, distal margin, and proximal margin were 330.63 ± 47.24 min, 57.50 ± 37.70 mL, 18.63 ± 10.57, 3.63 ± 0.88 cm, 3.50 ± 1.31 cm, and 3.63 ± 1.19 cm, respectively. None of the cases required conversion to laparotomy. Postoperative complications occurred in two (25.0%) patients. Postoperative complications were hyperamylasemia and gastric stasis in one case and incision infection in the other. Time to first flatus was 3.75 ± 2.49 d after the operation, and postoperative hospital stay was 10.13 ± 4.55 d. The core technique in the Da Vinci Xi RAPPG is lymph node dissection and the anatomic method of the nerve. Robotic surgical procedures are feasible and safe. With the progress of surgical technology, optimization of medical insurance structure, and emergence of evidence-based medicine, automated surgery systems will have a broad application in clinical treatment.

Perioperative outcomes of laparoscopy-assisted pylorus and vagus nerve-preserving gastrectomy and distal gastrectomy for middle-third early gastric cancer

Perioperative outcomes of laparoscopy-assisted pylorus and vagus nerve-preserving gastrectomy and distal gastrectomy for middle-third early gastric cancer

High-Resolution Manometry Reveals Normal Esophageal Motility, Including Lower Esophageal Sphincter Function, After Vagus Nerve-Preserving Gastrectomy

Objective: We developed two new methods to preserve lower esophageal sphincter (LES) function and the vagus nerve in performing total gastrectomy (TG) and partial cardiectomy (PC) for patients with early-stage gastric cancer. We used two methods compared to standard TG and evaluated outcomes using high-resolution manometry (HRM) to analyze esophageal function. Methods: We used HRM to evaluate 38 patients who underwent gastrectomy between April 2012 and September 2015. Nine, 13, and 16 patients underwent standard TG (Group A), LES and vagus nerve-preserving (LES-VNP) TG (Group B), and LES-VNP-PC (Group C), respectively. The differences among the mean values of DCI, IRP, CFV, and LESP were evaluated using Student’s ttest. In addition, post-hoc sample analysis was performed. Results: LES function and normal peristalsis of the esophagus were observed in 9 of 13 patients in Group B. LES pressure (LESP) was observed in all but 1 patient, and 6 in Group C exhibited normal LESP. Normal peristalsis was observed in 11 patients, although weak or failed contraction was observed in 5 patients each, respectively. In contrast, 1 of the 9 patients in Group A exhibited normal LESP. Normal peristalsis of the esophagus was observed in 6 patients, although the distal contractile interval was less than the normal range. Furthermore, in 3 patients each, weak or no contraction of the esophagus was observed. The LESP in Group B and Group C was significantly higher compared with that in Group A (p= 0.0275, 0.007, respectively). There were no significant differences in the values of the other variables between groups. In post hoc analysis, there were no significant differences between Group A and Group B only in CFV (p=0.0345). Conclusion: Our new technique shows promise for preserving LES function as well as esophageal peristalsis.

When is Vagus Nerve-Preserving Gastrectomy for Gastric Cancer Safe?

When is Vagus Nerve-Preserving Gastrectomy for Gastric Cancer Safe?

SURGICAL TECHNIQUE OF VAGUS NERVE‐PRESERVING GASTRECTOMY WITH D2 LYMPHADENECTOMY FOR GASTRIC CANCER

Preservation of the vagus nerve in curative gastrectomy for gastric cancer is important to maintain postoperative quality of life. We developed a vagus nerve-preserving gastrectomy with D2 dissection for patients with early gastric cancer and for selected patients with T2 cancer. Following lymph node dissection along the left gastric artery, the root of the left gastric artery was isolated and divided. The coeliac branch was followed retrogradely, and the posterior gastric branches were cut at their origins. The hepatic branch was also preserved. A total of 136 patients, including 27 cases of T2 cancer, underwent the vagus nerve-preserving gastric operation, and surgical anatomy of the coeliac branch was studied. In 110 cases, variations in the course of the coeliac branch were classified into three types according to its relationship with the left gastric artery: close to the artery (43 cases, 39.1%), intermediate (47 cases, 42.7%) and away from the artery (20 cases, 18.2%). In 115 patients who underwent vagus nerve-preserving distal gastrectomy (n = 93) or pylorus-preserving gastrectomy (n = 22), the postoperative bodyweight was 95.6 +/- 5.2% of the preoperative bodyweight, and the incidence of gallstone formation was 1.8% (2 of 113). A D2 dissection comparable with conventional D2 gastrectomy could be carried out using the vagus nerve-preserving technique. The coeliac branch could be preserved regardless of its anatomy, resulting in improvements in postoperative quality of life.