Is it necessary to dissect the posterior lymph nodes along the splenic vessels during total gastrectomy with D2 lymphadenectomy for advanced gastric cancer?

2017 ◽  
Vol 43 (12) ◽  
pp. 2357-2365 ◽  
Author(s):  
Jian-Xian Lin ◽  
Chang-Ming Huang ◽  
Chao-Hui Zheng ◽  
Ping Li ◽  
Jian-Wei Xie ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
D2 Lymphadenectomy ◽  
Splenic Vessels

scholarly journals Totally Laparoscopic Total Gastrectomy with D2 Lymphadenectomy for Advanced Gastric Cancer

2015 ◽  
Vol 06 (06) ◽  
pp. 247-254
Author(s):  
Hironobu Takano ◽  
Yuma Ebihara ◽  
Yo Kurashima ◽  
Soichi Murakami ◽  
Toshiaki Shichinohe ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
Laparoscopic Total Gastrectomy ◽  
D2 Lymphadenectomy ◽  
Totally Laparoscopic Total Gastrectomy ◽  
Totally Laparoscopic

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

1999 ◽  
Vol 2 (4) ◽  
pp. 230-234 ◽  
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

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

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.

scholarly journals ADJUVANT CHEMORADIOTHERAPY AFTER SUBTOTAL OR TOTAL GASTRECTOMY AND D2 LIMPHADENECTOMY INCREASES SURVIVAL IN ADVANCED GASTRIC CANCER?

2019 ◽  
Vol 32 (4) ◽  
Author(s):  
Nelson Adami ANDREOLLO ◽  
Eric DRIZLIONOKS ◽  
Valdir TERCIOTI-JUNIOR ◽  
João de Souza COELHO-NETO ◽  
José Antonio Possato FERRER ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
Adjuvant Treatment ◽  
Subtotal Gastrectomy ◽  
Adjuvant Chemoradiotherapy ◽  
Curative Intent ◽  
Number Of Patients ◽  
Significant Difference

ABSTRACT Background: The treatment of advanced gastric cancer with curative intent is essentially surgical and chemoradiotherapy is indicated as neo or adjuvant to control the disease and prolong survival. Aim: To assess the survival of patients undergoing subtotal or total gastrectomy with D2 lymphadenectomy followed by adjuvant chemoradiotherapy. Methods: Were retrospectively analyzed 87 gastrectomized patients with advanced gastric adenocarcinoma, considered stages IB to IIIC and submitted to adjuvant chemoradiotherapy (protocol INT 0116). Tumors of the esophagogastric junction, with peritoneal implants, distant metastases, and those that had a compromised surgical margin or early death after surgery were excluded. They were separated according to the extention of the gastrectomy and analyzed for tumor site and histopathology, lymph node invasion, staging, morbidity and survival. Results: The total number of patients who successfully completed the adjuvant treatment was 45 (51.7%). Those who started treatment and discontinued due to toxicity, tumor-related worsening, or loss of follow-up were 10 (11.5%) and reported as incomplete adjuvant. The number of patients who refused or did not start adjuvant treatment was 33 (48.3%). Subtotal gastrectomy was indicated in 60 (68.9%) and total in 27 (31.1%) and this had a shorter survival. The mean resected lymph nodes was 30.8. Staging and number of lymph nodes affected were predictors of worse survival and the more advanced the tumor. Patients undergoing adjuvant therapy with complete chemoradiotherapy showed a longer survival when compared to those who did it incompletely or underwent exclusive surgery. On the other hand, comparing the T4b (IIIB + IIIC) staging patients who had complete adjuvance with those who underwent the exclusive operation or who did not complete the adjuvant, there was a significant difference in survival. Conclusion: Adjuvant chemoradiotherapy presents survival gain for T4b patients undergoing surgical treatment with curative intent.

Long-Term Outcomes of Laparoscopic versus Open Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score-Matched Analysis

2019 ◽  
Vol 37 (3) ◽  
pp. 220-228 ◽  
Author(s):  
Hayemin Lee ◽  
Wook Kim ◽  
Junhyun Lee
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Propensity Score ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
Disease Free Survival ◽  
Term Survival ◽  
Open Total Gastrectomy

Background: Laparoscopic total gastrectomy (LTG) for advanced gastric cancer (AGC) is a technically and oncologically challenging procedure for surgeons. Objectives: The aim of this study was to compare the technical safety and long-term oncological feasibility between LTG and open total gastrectomy (OTG) for patients with AGC using a propensity score (PS)-matched analysis. Methods: Between 2004 and 2014, 185 patients (OTG: 127, LTG: 58) underwent curative total gastrectomy for AGC. PS matching was performed using the patients’ clinicopathological factors, and comparisons were made based on surgical outcomes and long-term survival rates. Results: After PS matching, 102 patients (51 patients in each group) were enrolled. The total numbers of retrieved lymph nodes were similar in both groups. The numbers of retrieved lymph nodes around the splenic hilum were similar in both groups. A longer operation time was required for the LTG group than for the OTG group, but less intraoperative bleeding was observed in the LTG group. The overall morbidity and mortality rates of both groups were similar. Between the 2 groups, there was no difference in the 5-year overall survival rate or disease-free survival rate. Conclusions: For treating proximal AGC, LTG may be a technically and an oncologically safe and feasible method.

Laparoscopic Total Gastrectomy with D2 Lymphadenectomy for Advanced Gastric Cancer

2012 ◽  
Vol 36 (10) ◽  
pp. 2394-2399 ◽  
Author(s):  
Ju-Hee Lee ◽  
Sang-Hoon Ahn ◽  
Do Joong Park ◽  
Hyung-Ho Kim ◽  
Hyuk-Joon Lee ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
Laparoscopic Total Gastrectomy ◽  
D2 Lymphadenectomy

scholarly journals Laparoscopic Versus Open Total Gastrectomy for Advanced Gastric Cancer: A Multicenter, Propensity Score-Matched Cohort Study in China

2021 ◽  
Vol 11 ◽  
Author(s):  
Xingyu Feng ◽  
Xin Chen ◽  
Zaisheng Ye ◽  
Wenjun Xiong ◽  
Xueqing Yao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Postoperative Complications ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
Disease Free Survival ◽  
D2 Lymphadenectomy ◽  
Significant Difference ◽  
Open Total Gastrectomy

BackgroundGiven the great technical difficulty and procedural complexity of laparoscopic total gastrectomy (LTG), the technical and oncologic safety of LTG versus open total gastrectomy (OTG) in the field of advanced gastric cancer (AGC) is yet undetermined.ObjectiveThis multicenter cohort study aimed to compare the surgical and oncological outcomes of LTG with those of OTG in AGC patients.Patients and MethodsIn total, 588 patients from 3 centers who underwent primary total gastrectomy with D2 lymphadenectomy, by well-trained surgeons with adequate experience, for pathologically confirmed locally AGC (T2N0–3, T3N0–3, or T4N0–3) between January 1, 2011, and December 31, 2015, were identified, and their clinical data were collected from three participating centers. After 1:1 propensity score matching (PSM), 450 cases (LTG, n = 225; OTG, n = 225) were eligible and assessed.ResultsNo significant difference in the number of retrieved lymph nodes, 5-year disease-free survival (DFS) rates, or 5-year overall survival (OS) rates between both surgical groups were observed. Although LTG had significantly longer surgical time (262 vs. 180 min, p < 0.001), LTG was associated with fewer postoperative complications [relative risk (RR) 0.583, 95% CI 0.353–0.960, p = 0.047), less intraoperative bleeding (120 vs. 200 ml, p < 0.001), longer proximal margin resection (3 vs. 2 cm, p < 0.001), and shorter postoperative hospitalization (11 vs. 13 days, p < 0.001). The mortality rate was comparable in both groups.ConclusionsLTG was not inferior to OTG in terms of survival outcomes and was associated with shorter surgical and postoperative hospitalization time and fewer postoperative complications, suggesting LTG with D2 lymphadenectomy as an important alternative to OTG for patients with AGC, but to be carried out in highly experienced centers.

scholarly journals Pancreatic enzymatic mediastinitis followed by total gastrectomy with splenectomy: report of two cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yoko Zaitsu ◽  
Takashi Nishizaki ◽  
Takuma Izumi ◽  
Daisuke Taniguchi ◽  
Yuichiro Kajiwara ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Abdominal Surgery ◽  
Ct Scan ◽  
Pancreatic Fistula ◽  
Medical History ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
Upper Body ◽  
History Of ◽  
Acute Mediastinitis

Abstract Background Acute mediastinitis is a rare disease that rapidly progresses with a high mortality rate. Its most common cause is direct injury of the mediastinum, including iatrogenic causes such as cardiac surgery or upper endoscopy. Enzymatic mediastinitis is a rare complication of a pancreatic fistula caused by the inflammatory digestion of the parietal peritoneum spreading to the mediastinum. Here, we present two cases of enzymatic mediastinitis caused by total gastrectomy with splenectomy. One of them was successfully treated and cured after early diagnosis and transabdominal drainage. Case presentation Case 1 was that of a 60-year-old man (body mass index [BMI] 27) with a medical history of diabetes and hypertension who was diagnosed with advanced gastric cancer in the upper body of the stomach. A total gastrectomy with splenectomy was performed. The patient experienced acute respiratory failure 24 h after surgery. Pulmonary embolism was suspected, so a computed tomography (CT) scan was performed; however, no relevant causes were found. Although he was immediately intubated and treated with catecholamine, he died in the intensive care unit (ICU) 40 h after surgery. Post-mortem findings revealed retroperitonitis caused by a pancreatic fistula spreading towards the mediastinum, causing severe mediastinitis; a review of the CT scan revealed pneumomediastinum. We concluded that the cause of death was enzymatic mediastinitis due to post-gastrectomy pancreatic fistula. Case 2 involved a 61-year-old man (BMI 25) with a medical history of appendicitis who was diagnosed with advanced gastric cancer at the gastric angle between the lesser curvature and the pylorus, spreading to the upper body of the stomach. A total gastrectomy with splenectomy was also performed. The patient had a high fever 3 days after the surgery, and a CT scan revealed pneumomediastinum, indicating mediastinitis. As the inflammation was below the bronchial bifurcation, we chose a transabdominal approach for drainage. The patient was successfully treated and discharged. Conclusion Acute mediastinitis caused by gastrectomy is rare. The acknowledgment of abdominal surgery as a cause of mediastinitis is important. In treating mediastinitis caused by abdominal surgery, transabdominal drainage may be a minimally invasive yet effective method if the inflammation is mainly located below the bifurcation of the trachea.

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