RA01.05: MINIMALLY INVASIVE ESOPHAGECTOMY AND 3-FIELD LYMPH NODE DISSECTION (ESOPHAGEAL SUSPENSION METHOD)—FUJIAN MEDICAL UNIVERSITY UNION HOSPITAL EXPERIENCE

Description We have modified our procedures of lymphadenectomy, with the purpose of radical lymph node dissection, because we believe that radical lymph node dissection along bilateral RLNs may be crucial for post-operative accurate staging, local control and better prognosis. Programmed lymphadenectomy includes several steps. Programmed extensive lymphadenectomy along right RLN included 3 steps: (1) Location of the right vagus nerve. (2) Loaction of the root of the right RLN. (3) Extensive lymphadenectomy. Programmed extensive lymphadenectomy along left RLN was conducted subsequently, which included 4 steps. (1) Esophageal suspension. (2) Lymph node rolling.(3) Location and identification of left RLN. (4) Extensive lymphadenectomy. During the whole procedure, we preferred to use blunt separation in the zones near the RLN, and preferred to use the ultrasound knife and scissors rather than electrical knife. The thoracic esophagus was not cut off during the procedure. After the thoracic procedures, we do the laparoscopic gastric dissociation and lymph node dissection. When metastasis to either RLN chains was confirmed by routine intra-operative frozen section, bilateral cervical lymphadenectomy was also performed. We divided the procedures into steps, which could have following advantages: more radical lymph node clearance with skeletonization of the nerves, reduced injuries due to definite location and identification of the nerves, more easier for surgeons to expose the surgical field and more easier for new-hands to master the procedures. Minimally invasive esophageactomy and thoracoscopic programmed extensive lymphadenectomy along the left and right RLNs in esophagectomy was feasible and safe. According to our study, programmed extensive lymphadenectomy yielded sufficient lymph nodes, with acceptable postoperative complications. Disclosure All authors have declared no conflicts of interest.

How to improve the lymph node detection and staging accuracy in gastric cancer patients: A randomized controlled trial in single center.

e15577 Background: To evaluate the effects of carbon nanoparticles by subserosa injection and different Lymph node retrievals by surgeon or pathologist in improving the positive and total lymph node detection and staging accuracy in patients who undergone the standard D2 gastrectomy. Methods: We collected 200 gastric cancer patients who undergone the standard D2 radical lymph node resection gastrectomy from November 2013 to November 2014 in Gastrointestinal Surgery Ward of Yantai Yuhuangding Hospital. The cases were randomly devidided into 4 groups (N = 50): Pathologist group(PA), surgeon group(SU), surgeon plus carbon nanoparticles group(SU+CN), pathologist plus carbon nanoparticles group (PA+CN) . The number of lymph nodes and the proportion of TNM stages were calculated respectively. Results: In the positive and total number of lymph nodes in all cases, it is significantly higher in Group SU than Group PA (3.64±4.32 VS 2.63±3.45),( 25.46±5.24 VS 20.23±6.32),Group SU+CN than Group PA (4.56±3.86 VS 2.63±3.45 ),(30.76±8.42 VS 20.23±6.32), Group PA+CN than Group PA(3.83±2.09 VS 2.63±3.45),(24.98±6.01 VS 20.23±6.32), Group SU+CN than Group SU(4.56±3.86 VS 2.63±3.45),(30.76±8.42 VS 25.46±5.24), Group SU+CN than Group PA+CN(4.56±3.86 VS 3.83±2.09),( 30.76±8.42 VS 24.98±6.01) (P < 0.05). The proportion of each TNM stage is significantly different in Group SU VS Group PA, Group SU+CN VS Group PA, Group PA+CN VS Group PA, Group SU+CN VS Group SU, Group SU+CN VS Group PA+CN(P < 0.05), while it is similar in Group PA+CN VS Group SU(P < 0.05). The highest proportion of Stage I and II and the lowest proportion of Stage III is in Group PA, and in Group SU+CN by contrary. Multivariate analysis shows carbon nanoparticles by subserosa injection and lymph node retrievals by surgeon are independent factors. Conclusions: Carbon nanoparticles by subserosa injection and lymph node retrievals by surgeon could be used as independent factors to improve the number of positive and total lymph nodes in standard D2 radical lymph node resection gastrectomy. It may also improve the accuracy of pathological staging of gastric cancer patients. Clinical trial information: ChiCTR-TRC-14876411.