Surgical technique of suprapancreatic D2 lymphadenectomy focusing on the posterior hepatic plexus for advanced gastric cancer

PURPOSE It is unclear whether laparoscopic distal gastrectomy for locally advanced gastric cancer is oncologically equivalent to open distal gastrectomy. The noninferiority of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer compared with open surgery in terms of 3-year relapse-free survival rate was evaluated. PATIENTS AND METHODS A phase III, open-label, randomized controlled trial was conducted for patients with histologically proven locally advanced gastric adenocarcinoma suitable for distal subtotal gastrectomy. The primary end point was the 3-year relapse-free survival rate; the upper limit of the hazard ratio (HR) for noninferiority was 1.43 between the laparoscopic and open distal gastrectomy groups. RESULTS From November 2011 to April 2015, 1,050 patients were randomly assigned to laparoscopy (n = 524) or open surgery (n = 526). After exclusions, 492 patients underwent laparoscopic surgery and 482 underwent open surgery and were included in the analysis. The laparoscopy group, compared with the open surgery group, suffered fewer early complications (15.7% v 23.4%, respectively; P = .0027) and late complications (4.7% v 9.5%, respectively; P = .0038), particularly intestinal obstruction (2.0% v 4.4%, respectively; P = .0447). The 3-year relapse-free survival rate was 80.3% (95% CI, 76.0% to 85.0%) for the laparoscopy group and 81.3% (95% CI, 77.0% to 85.0%; log-rank P = .726) for the open group. Cox regression analysis after stratification by the surgeon revealed an HR of 1.035 (95% CI, 0.762 to 1.406; log-rank P = .827; P for noninferiority = .039). When stratified by pathologic stage, the HR was 1.020 (95% CI, 0.751 to 1.385; log-rank P = .900; P for noninferiority = .030). CONCLUSION Laparoscopic distal gastrectomy with D2 lymphadenectomy was comparable to open surgery in terms of relapse-free survival for patients with locally advanced gastric cancer. Laparoscopic distal gastrectomy with D2 lymphadenectomy could be a potential standard treatment option for locally advanced gastric cancer.

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Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center

Scientific Reports ◽

10.1038/s41598-020-63616-1 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 5

Author(s):

Shan-ping Ye ◽

Jun Shi ◽

Dong-ning Liu ◽

Qun-guang Jiang ◽

Xiong Lei ◽

...

Keyword(s):

Gastric Cancer ◽

Propensity Score ◽

Advanced Gastric Cancer ◽

Propensity Score Matching ◽

Distal Gastrectomy ◽

High Capacity ◽

D2 Lymphadenectomy ◽

Short Term ◽

Laparoscopic Assisted

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Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer

Gastric Cancer ◽

10.1007/s101200050069 ◽

1999 ◽

Vol 2 (4) ◽

pp. 230-234 ◽

Cited By ~ 157

Author(s):

Ichiro Uyama ◽

Atsushi Sugioka ◽

Junko Fujita ◽

Akitake Hasumi ◽

Yoshiyuki Komori ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Total Gastrectomy ◽

Laparoscopic Total Gastrectomy ◽

D2 Lymphadenectomy ◽

Distal Pancreatosplenectomy

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Prognostic Significance of Preoperative Serum Uric Acid to Lymphocyte Ratio in Advanced Gastric Cancer A Propensity Score-Matched Analysis

10.21203/rs.3.rs-213684/v1 ◽

2021 ◽

Author(s):

Li Heng Liu ◽

Shan Shan Hu ◽

Cheng Lei Liao ◽

ziwei wang

Keyword(s):

Gastric Cancer ◽

Uric Acid ◽

Propensity Score ◽

Advanced Gastric Cancer ◽

Prognostic Significance ◽

D2 Lymphadenectomy ◽

Entire Cohort ◽

Lymphocyte Ratio ◽

Incidence And Mortality ◽

High Level

Abstract Purpose: Gastric cancer ranks sixth and second in incidence and mortality among all cancer. The purpose of our research was to evaluate the prognostic value of uric acid to lymphocyte ratio (ULR) for advanced gastric cancer (AGC) patients after gastrectomy with D2 lymphadenectomy.Methods: In this research, we included 287 AGC patients underwent gastrectomy with D2 lymphadenectomy. These patients were followed up for 5 years, and their clinicopathological data were collected. All patients were divided into two groups based on the preoperative ULR level. Then we established the propensity score matching (PSM) cohort to confirm our results. Finally, The clinical characteristics and survival indexes of the two groups in the PSM cohort and the entire cohort were compared. Results：We found that age and gender were significantly correlated with the ULR level. Multivariate analysis for the entire cohort and PSM cohort showed that high levels of ULR, poor differentiation, postoperative pathology of T4 stage, and regional lymph node metastasis were independent prediction factors for poor outcomes of overall survival (OS) and Disease-free survival (DFS) in patients with AGC after gastrectomy with D2 lymphadenectomy. Survival analysis showed that the OS and DFS in the high level ULR group were significantly shorter than in the low level ULR group (log-rank P < 0.001). Conclusion: High level ULR is a poor predictive factor for patients with AGC underwent gastrectomy with D2 lymphadenectomy, and high levels of ULR predict shorter OS and DFS.

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Short-term outcomes of laparoscopic D2 gastrectomy with complete mesogastrium excision (D2+CME) for advanced gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.43 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 43-43

Author(s):

Daxing Xie ◽

Jianping Gong

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Cancer Cells ◽

Advanced Gastric Cancer ◽

Surgical Outcomes ◽

Soft Tissues ◽

R0 Resection ◽

D2 Lymphadenectomy ◽

Short Term ◽

The Mean

43 Background: D2 lymphadenectomy has been widely accepted as a standard procedure of surgical treatment for local advanced gastric cancer [1,2]. However, neither the dissection boundary nor the extent of the excision for perigastric soft tissues has been described [3-7]. Our previous researches demonstrate the existence of disseminated cancer cells in the mesogastrium [8, 9] and present an understandable mesogastrium model for gastrectomy [10]. Hence, the D2 lymphadenectomy plus complete mesogastrium excision (D2+CME) is firstly proposed in this study, aiming to assess the safety, feasibility and corresponding short-term surgical outcomes. Methods: All of these patients underwent laparoscopy assisted D2+CME radical gastrectomy with a curative R0 resection, and all the operation was performed by Prof. Jianping Gong, chief of GI surgery of Tongji Hospital, Huazhong University of Science and Technology. All participants provided informed written consent to participate in the study. This study was approved by the Tongji Hospital Ethics Committee. The standard surgical procedures in the video are described as follows. Reconstruction of the alimentary tract was done by extracorporeal anastomosis. Standard recovery protocols were followed in postoperative treatments. Results: 68 patients between September 2014 and March 2016 have been recruited with informed consent and underwent laparoscopic D2+CME by a single surgeon. The mean number of retrieved regional lymph nodes was 33.62±11.40 (ranges 14-55). The mean volume of blood loss was 12.44±22.89 ml (ranges 5-100). The mean laparoscopic surgery time was 127.82±17.63 mins (ranges 110-165). The mean hospitalization time was 16.5±3.3 days (ranges 8-28). No operative complication was observed during the hospitalization. Conclusions: The anatomical boundary of mesogastrium is well described and dissected within D2+CME surgical process. It proves to be safely feasible and repeatable with less blood lost, qualified lymph nodes, retrieval results, and other improved short-term surgical outcomes in advanced gastric cancer. Meanwhile, potential disseminated cancer cells fall into the mesogastrium can be eradicated by D2+CME. Clinical trial information: NCT01978444.

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