scholarly journals Simplified technique for reconstruction of the digestive tract after total and subtotal gastrectomy for gastric cancer

2014 ◽  
Vol 27 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Bruno ZILBERSTEIN ◽  
Carlos Eduardo JACOB ◽  
Leandro Cardoso BARCHI ◽  
Osmar Kenji YAGI ◽  
Ulysses RIBEIRO-JR ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Anastomotic Leakage ◽  
Operative Time ◽  
Subtotal Gastrectomy ◽  
Linear Stapler ◽  
Laparoscopic Technique ◽  
Esophagojejunal Anastomosis ◽  
Upper Abdomen ◽  
Postoperative Staging

BACKGROUND: Laparoscopic surgery has been increasingly applied to gastric cancer surgery. Gastrointestinal tract reconstruction totally done by laparoscopy also has been a challenge for those who developed this procedure. AIM - To describe simplified reconstruction after total or subtotal gastrectomy for gastric cancer by laparoscopy and the results of its application in a series of cases. METHODS - In the last four years, 75 patients were operated with gastric cancer and two with GIST. Thirty-four were women and 43 men. The age ranged from 38 to 77 years with an average of 55 years. In two patients with GIST a total and a subtotal gastrectomy were performed. In the other 75 patients were done 21 total gastrectomies and 54 subtotal. In all cancers, gastrectomy with D2 lymphadenectomy was completed with at least 37 lymph nodes removed. Was used in these operations a modified laparoscopic technique proposed by the authors consisting in a latero lateral esophagojejunal anastomosis with linear stapler in TG as well in STG, and reconstruction of the digestive continuity also in the upper abdomen. RESULTS - The intraoperative and immediate postoperative course were uneventful, except for one case of bleeding due to an opening clip, necessitating re-intervention. The operative time was 300 minutes, with no difference between total or subtotal gastrectomy. The number of lymph nodes removed varied from 28 to 69, averaging 37. Postoperative staging showed one case in T4 N2 M0; 13 in T2 N0 MO; 27 in T2 N1 M0; 24 in T3 N1 M0 and 10 in T3 N2 M0. Complication in only one case was observed on the 10th postoperative day with a small anastomotic leakage in esophagojejunal anastomose with spontaneous closure. CONCLUSION - The patient's evolution with no complications, no mortality and just one small anastomotic leakage with no systemic repercussions is a strong indication of the liability and feasibility of this innovative technical method.

Kinh nghiệm qua 126 bệnh nhân phẫu thuật nội soi cắt toàn bộ dạ dày điều trị ung thư dạ dày

2021 ◽  
Author(s):  
Van Huong Nguyen
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Total Gastrectomy ◽  
Operative Time ◽  
Laparoscopic Total Gastrectomy ◽  
Oral Feeding ◽  
Linear Stapler ◽  
The Mean ◽  
End To End ◽  
Mean Time

TÓM TẮT Đặt vấn đề: Báo cáo kinh nghiệm về kỹ thuật phẫu thuật nội soi cắt toàn bộ dạ dày qua 126 bệnh nhân điều trị ung thư dạ dày tại Bệnh viện Hữu nghị Đa khoa Nghệ An. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả hồi cứu, các bệnh nhân được phẫu thuật nội soi cắt toàn bộ dạ từ 2014 đến 05/2021. Kết quả: Có 126 bệnh nhân, tuổi trung bình 60,6 ± 11,1 tuổi. 15,9% ung thư 1/3 trên dạ dày và 81,7% là 1/3 giữa. Ung thư ở giai đoạn I, II, III là 19,0%, 49,2%, 31,7%. 71,4% PTNS hoàn toàn cắt TBDD và nối lưu thông tiêu hóa bằng máy cắt nối thẳng. 3,2% trường hợp có tai biến trong mổ và 2,4% có biến chứng sau mổ, không có trường hợp nào tử vong. Số hạch nạo vét được trung bình 22,06 ± 7,6 hạch, lượng máu mất trung bình là 32,14 ± 10,4 ml, thời gian phẫu thuật trung bình là 210,4 ± 34,3 phút, thời gian nằm viện trung bình là 8,3 ± 2,5 ngày và thời gian sống thêm toàn bộ sau mổ trung bình là 36,9 ± 2,25 tháng. Kết luận: PTNS cắt TBDD là kỹ thuật an toàn và hiệu quả trong điều trị UTDD, nối thực quản hỗng tràng bằng máy cắt nối thẳng không cắt thực quản và hỗng tràng trước là kỹ thuật an toàn, tiết kiệm. Từ khóa: Kỹ thuật phẫu thuật nội soi dạ dày, ung thư dạ dày. ABSTRACT EXPERIENCE IN 126 PATIENTS OF LAPAROSCOPIC TOTAL GASTRECTOMY FOR THE TREATMENT OF GASTRIC CANCER Background: The goal of this study was to report on the experience of laparoscopic total gastrectomy (LTG) in 126 patients with gastric cancer Materials and Methods: Retrospective descriptive study of 126 patients who underwent LTG for gastric cancer between 2014 and May 2021. Results: Mean age 60,6 ± 11,1; gastric cancer at stage I, II, III was 19,0%, 49,2%, 31,7% respectively. 71,4% patients underwent totally LTG and functional end-to-end esophagojejunostomy by linear stapler without previous resection of esophagus and jejunum. 3.2% of cases had complications during surgery and 2,4% of cases had complications after surgery. There was no postoperative deaths. The average number of dredged lymph nodes was 22.06 ± 7.6 lymph nodes. The mean blood loss was 32.14 ± 10.4 ml. The mean operative time was 210.4 ± 34.3 minutes. The mean time for beginning oral feeding was 4.4 ± 1.9 days. The mean hospital stay was 8.3 ± 2.5 days. The mean overall survival was 36.9 ± 2,25 months. Conclusions: LTG is a safe and effective technique for the treatment of gastric cancer. The technique functional end-to-end esophagojejunostomy by linear stapler without previous resection of esophagus and jejunum was safe and saving. Keywords: Technique of laparoscopic gastrectomy, gastric cancer

scholarly journals Risk factors of esophagojejunal anastomosis leakage after total gastrectomy

2013 ◽  
Vol 12 (1-2) ◽  
pp. 0-0
Author(s):  
Mindaugas Kiudelis ◽  
Jonas Bernotas ◽  
Antanas Mickevičius ◽  
Žilvinas Endzinas ◽  
Almantas Maleckas
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Lymph Nodes ◽  
Anastomotic Leakage ◽  
Total Gastrectomy ◽  
Operative Time ◽  
White Blood Cells ◽  
Radical Gastrectomy ◽  
Esophagojejunal Anastomosis ◽  
Anastomosis Leakage

Background/AimEsophagojejunal anastomotic leakage (EJAL) after total gastrectomy is one of the most frequent life-threatening complications. The rate of EJAL after total gastrectomy is about 2–11% worlwide. The aim of this study was to identify the independent prognostic risk factors that may predict EJAL progression for patients after total gastrectomy.Materials and methodsThis retrospective study analyzed medical records of 175 patients. All these patients had underwent radical gastrectomy due to gastric cancer. The analyzed factors were: age, gender, American Society of Anaesthesiologists (ASA) funtional class, splenectomy, anastomosis technique, operative time, cancer stage, the number of dissected lymph nodes, the number of metastatic lymph nodes, resection margins. White blood cells count, C reactive protein (CRP) value, body temperature, drain output were calculated in the early postoperative period.ResultsThe average age of the patients was 63.2 ± 11.5 years. The EJAL rate was found to be 6.3%. The mortality rate among patients who developed EJAL was 9%. Postoperative laboratory and clinical findings significantly related to EJAL were the average temperature of 4 postoperative days >37.2 oC (p = 0.018), postoperative white blood cell count >16.7 x 109/l (p = 0.031), postoperative CRP level >160 mg/l (p = 0.001) and operative time >248 min (p = 0.009), although the binary logistic regression analysis revealed that none of these variables can be used as statisticaly significant predictors for EJAL.ConclusionsThe esofagojejunal anastomotic leakage rate of 6.3% was found among patients undergoing radical gastrectomy due to gastric carcinoma. Mortality rate in case of EJAL increases up to 9%. In our study, we didn’t find any independent predictors for EJAL.Key words: gastrectomy, esophagojejunal anastomosis leakage, risk factorsEzofagojejuninės jungties nesandarumo išsivystymo rizikos veiksniai po gastrektomijosĮvadasEzofagojejuninės jungties nesandarumas (EJJN) po gastrektomijos yra viena iš didžiausią grėsmę gyvybei keliančių komplikacijų. Mokslinių tyrimų duomenimis, EJJN dažnis svyruoja nuo 2 iki 11 %. Darbo tikslas – nustatyti rizikos veiksnius,darančius įtaką ezofagojejuninės jungties nesandarumo vystymuisi po gastrektomijos dėl skrandžio vėžio, ir prognozuoti jų įtaką EJJN išsivystymui.Ligoniai ir metodaiRetrospektyviai ištirta 175 pacientų medicininė dokumentacija. Tirtiems pacientams 2006–2010 metais atlikta gastrektomija dėl skrandžio vėžio. Analizuoti veiksniai: amžius, lytis, Amerikos anesteziologų asociacijos (ASA) funkcinė klasė, splenektomija, jungties susiuvimo būdas, operacijos trukmė, naviko stadija, operacijos metu pašalintų limfmazgių skaičius, limfmazgių su mestazėmis skaičius, rezekciniai kraštai. Ankstyvuoju pooperaciniu laikotarpiu vertinta leukocitų kiekis, C reaktyviojo baltymo (CRB) koncentracija kraujyje, pooperacinė temperatūra, sekrecija pro drenus.RezultataiTirtų pacientų amžiaus vidurkis 63,2±11,5 metų. Vyrų 50,6 %, moterų 49,4 %. EJJN dažnis 6,3 %. Turėjusių EJJN pacientų mirtingumas siekė 9 %. Nustatyti rizikos veiksniai, statistiškai patikimai susiję su EJJN išsivystymu. Jų reikšmės patikslintosrandant ROC kreivės lūžio taškus: 4 parų vidutinė temperatūra 37,15oC (p=0,018), maksimalios leukocitų (11,7x109/l, p=0,031) ir C reaktyviojo baltymo reikšmės (159,95 mg/l, p=0,001), operacijos trukmė 247,5 min (p=0,009). Tačiau binarinė logistinė regresija parodė, kad šie kriterijai negali būti statistiškai patikimi prognoziniai EJJN vystymosi veiksniai.IšvadosEzofagojejuninės jungties nesandarumo dažnis po gastrektomijos dėl skrandžio vėžio yra 6,3%, šią komplikaciją turėjusių pacientų mirštamumas – 9%. Savo tyrime neradome prognostiškai reikšmingų rizikos veiksnių.Reikšminiai žodžiai: gastrektomija, ezofagojejuninės jungties nesandarumas, rizikos veiksniai

scholarly journals Risk factors of esophagojejunal anastomosis leakage after total gastrectomy

2013 ◽  
Vol 12 (1-2) ◽  
pp. 0-0
Author(s):  
Mindaugas Kiudelis ◽  
Jonas Bernotas ◽  
Antanas Mickevičius ◽  
Žilvinas Endzinas ◽  
Almantas Maleckas
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Lymph Nodes ◽  
Anastomotic Leakage ◽  
Total Gastrectomy ◽  
Operative Time ◽  
White Blood Cells ◽  
Radical Gastrectomy ◽  
Esophagojejunal Anastomosis ◽  
Anastomosis Leakage

Background/AimEsophagojejunal anastomotic leakage (EJAL) after total gastrectomy is one of the most frequent life-threatening complications. The rate of EJAL after total gastrectomy is about 2–11% worlwide. The aim of this study was to identify the independent prognostic risk factors that may predict EJAL progression for patients after total gastrectomy.Materials and methodsThis retrospective study analyzed medical records of 175 patients. All these patients had underwent radical gastrectomy due to gastric cancer. The analyzed factors were: age, gender, American Society of Anaesthesiologists (ASA) funtional class, splenectomy, anastomosis technique, operative time, cancer stage, the number of dissected lymph nodes, the number of metastatic lymph nodes, resection margins. White blood cells count, C reactive protein (CRP) value, body temperature, drain output were calculated in the early postoperative period.ResultsThe average age of the patients was 63.2 ± 11.5 years. The EJAL rate was found to be 6.3%. The mortality rate among patients who developed EJAL was 9%. Postoperative laboratory and clinical findings significantly related to EJAL were the average temperature of 4 postoperative days >37.2 oC (p = 0.018), postoperative white blood cell count >16.7 x 109/l (p = 0.031), postoperative CRP level >160 mg/l (p = 0.001) and operative time >248 min (p = 0.009), although the binary logistic regression analysis revealed that none of these variables can be used as statisticaly significant predictors for EJAL.ConclusionsThe esofagojejunal anastomotic leakage rate of 6.3% was found among patients undergoing radical gastrectomy due to gastric carcinoma. Mortality rate in case of EJAL increases up to 9%. In our study, we didn’t find any independent predictors for EJAL.Key words: gastrectomy, esophagojejunal anastomosis leakage, risk factorsEzofagojejuninės jungties nesandarumo išsivystymo rizikos veiksniai po gastrektomijosĮvadasEzofagojejuninės jungties nesandarumas (EJJN) po gastrektomijos yra viena iš didžiausią grėsmę gyvybei keliančių komplikacijų. Mokslinių tyrimų duomenimis, EJJN dažnis svyruoja nuo 2 iki 11 %. Darbo tikslas – nustatyti rizikos veiksnius,darančius įtaką ezofagojejuninės jungties nesandarumo vystymuisi po gastrektomijos dėl skrandžio vėžio, ir prognozuoti jų įtaką EJJN išsivystymui.Ligoniai ir metodaiRetrospektyviai ištirta 175 pacientų medicininė dokumentacija. Tirtiems pacientams 2006–2010 metais atlikta gastrektomija dėl skrandžio vėžio. Analizuoti veiksniai: amžius, lytis, Amerikos anesteziologų asociacijos (ASA) funkcinė klasė, splenektomija, jungties susiuvimo būdas, operacijos trukmė, naviko stadija, operacijos metu pašalintų limfmazgių skaičius, limfmazgių su mestazėmis skaičius, rezekciniai kraštai. Ankstyvuoju pooperaciniu laikotarpiu vertinta leukocitų kiekis, C reaktyviojo baltymo (CRB) koncentracija kraujyje, pooperacinė temperatūra, sekrecija pro drenus.RezultataiTirtų pacientų amžiaus vidurkis 63,2±11,5 metų. Vyrų 50,6 %, moterų 49,4 %. EJJN dažnis 6,3 %. Turėjusių EJJN pacientų mirtingumas siekė 9 %. Nustatyti rizikos veiksniai, statistiškai patikimai susiję su EJJN išsivystymu. Jų reikšmės patikslintosrandant ROC kreivės lūžio taškus: 4 parų vidutinė temperatūra 37,15oC (p=0,018), maksimalios leukocitų (11,7x109/l, p=0,031) ir C reaktyviojo baltymo reikšmės (159,95 mg/l, p=0,001), operacijos trukmė 247,5 min (p=0,009). Tačiau binarinė logistinė regresija parodė, kad šie kriterijai negali būti statistiškai patikimi prognoziniai EJJN vystymosi veiksniai.IšvadosEzofagojejuninės jungties nesandarumo dažnis po gastrektomijos dėl skrandžio vėžio yra 6,3%, šią komplikaciją turėjusių pacientų mirštamumas – 9%. Savo tyrime neradome prognostiškai reikšmingų rizikos veiksnių.Reikšminiai žodžiai: gastrektomija, ezofagojejuninės jungties nesandarumas, rizikos veiksniai

Safety of double and a half-layered esophagojejunal anastomosis in total gastrectomy with gastric cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16563-e16563
Author(s):  
Pengfei Ma ◽  
Yuzhou Zhao ◽  
Xijie Zhang
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Anastomotic Leakage ◽  
Total Gastrectomy ◽  
Operating Time ◽  
New Method ◽  
Control Group ◽  
Observation Group ◽  
Esophagojejunal Anastomosis

e16563 Background: Esophageal jejunal anastomotic fistula is still one of the serious postoperative complications of gastric cancer, the incidence was 1% ~ 16.5%. The aim of this study was to evaluate the safety of double and a half layered esophagojejunal anastomosis in total gastrectomy. Methods: The new method was called double and a half layered esophagojejunal anastomosis: esophagojejunal anastomosis was performed with a tubular stapler, then the anastomosis was reinforced by absorbable suture (Full-layer continuous suture, slurry muscularis embedding). The new method was used in observation group (n = 295). In the control group(n = 469),the esophagojejunal anastomosis was performed with a tubular stapler, then reinforced by intermittent suture with absorbable sutures. Data analysis including operating time, blood loss, anastomosis time, types and cases of postoperative complications, and postoperative hospitalization time. Results: The data of 764 patients who performed radical gastrectomy between May 2015 and May 2019 were analyzed retrospectively. 1.Surgery situations: The operating time (140.66±26.96 min vs 139.61±22.75min, t= 0.581, P> 0.05) blood loss (200.61±111.03ml vs214.45±114.09ml, t= -1.481, P> 0.05), anastomosis time (20.44±4.31min vs19.92±4.58min, t= 1.573, P> 0.05), postoperative hospitalization time (15.35±6.46 d vs15.89±5.58d, t= -1.229, P> 0.05) .2. Postoperative situations: the rates of anastomotic complications in observation group was 1.69% (5/295) and 4.69% (22/469) in control group, with a statistically significant difference between two groups( χ2 = 4.768, P< 0.05). The rates of anastomotic leakage in observation group was lower than that in the control group 1.02% (3/295) vs 3.41% (16/469) ( χ2 = 4.282, P< 0.05) . The severity of anastomotic leakage, anastomotic stenosis, anastomotic bleeding were no statistically significant differences between two groups( χ 2= 2.030,1.261,0.075, P> 0.05). Total postoperative complications: 101 cases (34.24%) in the observation group, 14 cases (4.75%) with severe complications, and 1 case death. 151 cases (32.2%) in the control group, 34 cases (7.25%) with serious complications, and 2 cases death ( χ2 = 0.838, Z = -1.465, P > 0.05). Conclusions: Double and a half layered esophagojejunal anastomosis is safe and feasible in total gastrectomy, which can reduce the incidence of anastomosis complications.

scholarly journals Clinicopathological Review of Resectable Gastric Cancer at a Tertiary Level Teaching Hospital of Nepal

2020 ◽  
Vol 42 (1) ◽  
pp. 74
Author(s):  
Prasan Kansakar ◽  
Pradeep Vaidya
Keyword(s):  
Gastric Cancer ◽  
Gastric Carcinoma ◽  
Lymph Nodes ◽  
Teaching Hospital ◽  
Curative Resection ◽  
Locally Advanced ◽  
Subtotal Gastrectomy ◽  
Distal Margin ◽  
Tumor Type ◽  
Borrmann Type

Introduction According to available data, gastric carcinoma is the most common malignancy arising from the gastrointestinal tract in Nepal. Our objective was to analyze the pathological features of gastric carcinoma in patients undergoing curative resection. MethodsRetrospective analysis of histopathological reports of patients who underwent curative surgery for gastric cancer was performed at Department of Surgery, Tribhuvan University Teaching Hospital for a period of two years. Demographic characteristics, symptoms, site of tumor, type of surgery performed, macroscopic and microscopic characteristics including number of harvested lymph nodes, number of positive lymph nodes and tumor stage were analyzed. ResultsA total of 36 patients underwent curative resection. Mean age of the patients was 61.6 years with range of 21-82 years. Male:female ratio was 7:4. Pain abdomen was the predominant presenting symptom. Vomiting, hematemesis and malena were the other frequent symptoms. Endoscopy Borrmann type II tumor was seen in 27 (75%) of patients. Most patients underwent subtotal gastrectomy. In 25 patients, tumor was located in antrum. Lymphovascular and perineural invasion was seen in 21 and 20 patients respectively. Sixteen patients had poorly differentiated tumors. All but two patients had microscopic negative distal margin whereas proximal margin was negative in all patients. A mean of 15 lymph nodes were harvested. Twenty three patients had node positive disease. Pathological staging revealed Stage IA in 3 patients, Stage IB in in 5 patients , stage IIA in 4 patients stage IIB in 6 patients, stage IIIA in 6 patients, stage IIIB in 8 patients and IIIC in 4 patients. ConclusionGastric carcinoma was common in seventh and eighth decade of life with male preponderance. Most of the patients presented with locally advanced gastric cancer. Tumors located in antrum requiring subtotal gastrectomy was the predominant finding.

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.

Lymph node mapping in gastric cancer: A pilot study in Western patients.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 192-192
Author(s):  
Akie Watanabe ◽  
Trevor D Hamilton
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Pilot Study ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Subtotal Gastrectomy ◽  
Median Number ◽  
Lymph Node Mapping ◽  
Indocyanine Green Fluorescence ◽  
Laparoscopic Subtotal Gastrectomy

192 Background: Adequate surgical lymphadenectomy is integral to the staging and treatment of gastric cancer. A number of Asian studies have explored the utility of lymph node (LN) mapping in gastric cancer but this in not commonly performed in Western countries. We sought to evaluate the utility and safety of LN mapping in Western patients. Methods: We conducted a pilot study of 13 patients with histologically proven non-metastatic gastric adenocarcinoma that received endoscopic peri-tumoral indocyanine green fluorescence (ICG) injections immediately prior to surgical resection to facilitate LN mapping. Illumination with ICG around the primary tumor, in lymphatic basins, tracts, and lymph nodes were confirmed by the PINPOINT system on recorded videos. Descriptive statistical analysis was performed. Results: Among the 13 patients enrolled, median age was 75 years and 7 were men. On pathologic review, 15% were T1, 54% were T2, and 69% had were node negative. Tumours were located in the proximal third in 1 patient, middle third in 2 patients and distal third in 10 patients. All patients had a laparoscopic subtotal gastrectomy and 10 patients had a D2 lymphadenectomy. 5 patients received preoperative and 7 received postoperative chemotherapy. The median number of LNs harvested was 26 [IQR 24-34]. Video confirmation of ICG mapping of the primary tumor, lymphatic basins, tracts, and LNs were obtained in all patients. All LNs identified with ICG uptake were removed with surgical lymphadenectomy. ICG mapped LNs fell outside the D1 distribution in 100% and outside the D1-plus distribution in 54% of cases. ICG mapped LNs were within the D2 distribution in all cases. No ICG related allergic reactions or procedural complications were observed. Postoperative complications included 2 grade A pancreatic fistulas, 1 gastrointestinal bleed, and 1 NSTEMI. Peri-operative morality was zero. Conclusions: We demonstrate ICG lymph node mapping as a safe and useful technique for identifying regional draining lymph nodes and for primary tumor localization in Western patients. The majority of cases found LNs draining outside the D1 and D1+ distributions, highlighting the importance of appropriate lymphadenectomies in gastric cancer.

Hand-assisted Laparoscopic Spleen-preserving Total Gastrectomy for Gastric Cancer: Technical Feasibility and Early Results

2013 ◽  
Vol 79 (4) ◽  
pp. 407-413
Author(s):  
Guang-Tan Zhang ◽  
Xue-Dong Zhang
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Lymph Nodes ◽  
Hospital Stay ◽  
Operative Time ◽  
Postoperative Hospital Stay ◽  
Injection Time ◽  
Spleen Preserving ◽  
Estimated Blood Loss ◽  
Method Group

To evaluate the feasibility and safety of hand-assisted laparoscopic spleen-preserving total gas-trectomy for gastric cancer, we compared the operative outcomes between two methods for dissection of lymph nodes along the distal splenic artery (No. 11d) and at the splenic hilum (No. 10). Sixty-four patients with proximal or total gastric cancer operated on in our department from October 2009 to February 2012 were divided into two groups: the extracorporeal method group (EMG) and the intracorporeal method group (IMG). Operative time, estimated blood loss, number of lymph node retrieval, times of analgesic injection, time to the first flatus, and postoperative hospital stay were compared between the two groups. Estimated blood loss, times of analgesic injection, time to the first flatus, and postoperative hospital stay were equivalent between the two groups. The operative time was significantly shorter in the IMG than the EMG. There were no significant differences in tumor size, retrieved lymph nodes, American Joint Committee on Cancer/Union for International Cancer Control staging, or resection margins between the two groups. Hand-assisted laparoscopic spleen-preserving total gastrectomy is technically feasible and safe and allows for adequate lymphadenectomy.

scholarly journals A Case of Advanced Gastric Cancer with Para-Aortic Lymph Node Metastasis Treated with Preoperative FOLFOX Chemotherapy Followed by Radical Subtotal Gastrectomy and D2 Lymph Node Dissection

2017 ◽  
Vol 10 (1) ◽  
pp. 182-191 ◽  
Author(s):  
Byoung Jo Suh
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Fdg Pet ◽  
Subtotal Gastrectomy ◽  
Pet Ct ◽  
Node Metastases ◽  
Folfox Chemotherapy ◽  
Fdg Pet Ct

We report the case of a 73-year-old female who was diagnosed with advanced gastric cancer. Esophagogastroduodenoscopy was used to diagnose Borrmann type 3 advanced gastric cancer located at the gastric antrum. A biopsy revealed poorly differentiated adenocarcinoma. Abdominopelvic computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography-CT (FDG-PET-CT) scans demonstrated multiple lymph node metastases, including the para-aortic lymph nodes. Systemic chemotherapy with 5-fluoruracil (5-FU), oxaliplatin, and leucovorin (FOLFOX) was initiated. An abdominopelvic CT scan taken after 4 cycles of chemotherapy showed improvement in the ulceroinfiltrative gastric lesion and marked regression of several enlarged lymph nodes. Consequently, we performed a subtotal gastrectomy with D2 lymphadenectomy. The postoperative histopathological report was early gastric carcinoma with no lymph node metastasis in the 48 resected lymph nodes. Another 4 cycles of FOLFOX chemotherapy were performed after surgery. A FDG-PET-CT scan taken 12 months postoperatively showed no definite evidence of local recurrence or distant metastasis, and the previously noted retroperitoneal lymph nodes had disappeared. A FDG-PET-CT taken 16 months postoperatively showed multiple lymph node metastases, including the left supraclavicular lymph node. Despite 8 cycles of secondary chemotherapy with 5-FU, irinotecan, and leucovorin (FOLFIRI) and radiotherapy, the patient died 38 months after the operation.

Topographic anatomy and laparoscopic technique for dissection of no. 6 infrapyloric lymph nodes in gastric cancer surgery

2013 ◽  
Vol 16 (4) ◽  
pp. 615-620 ◽  
Author(s):  
Hisashi Shinohara ◽  
Yasunori Kurahashi ◽  
Seiichiro Kanaya ◽  
Shusuke Haruta ◽  
Masaki Ueno ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Cancer Surgery ◽  
Laparoscopic Technique ◽  
Gastric Cancer Surgery ◽  
Topographic Anatomy ◽  
Infrapyloric Lymph Nodes
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