Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2022; 10(6): 1834-1842
Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1834
Superior pancreatic lymphadenectomy with portal vein priority via posterior common hepatic artery approach in laparoscopic radical gastrectomy
Yu-Jia Zhang, Rong-Chao Xiang, Jun Li, Yong Liu, Si-Ming Xie, Liang An, Hua-Lin Li, Gang Mai
Yu-Jia Zhang, Rong-Chao Xiang, Jun Li, Yong Liu, Si-Ming Xie, Liang An, Hua-Lin Li, Gang Mai, Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
Author contributions: Zhang YJ drafted the manuscript, and assisted with data analysis; Xiang RC participated in design and oversight of the study, and was involved with data collection; Li J participated in design of the study, and was involved with data collection; Liu Y was involved with data collection, and assisted with data analysis; Xie SM drafted the manuscript, and assisted with data analysis; An L and Li HL participated in study design and performed statistical analysis; Mai G participated in design of the study, was involved with data collection; all authors read and approved the final manuscript.
Institutional review board statement: The study has been approved by the ethics committee of the Deyang City People’s Hospital.
Clinical trial registration statement: The current study has not been registered, as the procedures of laparoscopic gastrectomy is a routine treatment of gastric cancers.
Informed consent statement: A waiver of informed consent was obtained, since the data were analyzed from the electronic medical record and reported without personal identifiers.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: Can be requested via contacting with the corresponding author.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gang Mai, MD, Chief Doctor, Department of General Surgery, Deyang City People's Hospital, No. 173 North Taishan Road, Deyang 618000, Sichuan Province, China. maigang68@hotmail.com
Received: July 27, 2021
Peer-review started: July 27, 2021
First decision: October 3, 2021
Revised: October 16, 2021
Accepted: January 17, 2022
Article in press: January 17, 2022
Published online: February 26, 2022
Processing time: 211 Days and 7.3 Hours
Abstract
BACKGROUND

D2 lymph node dissection for advanced gastric cancer is advocated, and station 8p lymph node should be considered in selected patients, which is, however, technically difficult.

AIM

To introduce a new and easy-to-perform procedure for dissection of the lymph nodes superior to the pancreas.

METHODS

A series of patients who underwent laparoscopic gastrectomy for gastric cancer were retrospectively included with utilization of a new procedure for superior pancreatic lymphadenectomy (LND) with portal vein priority via the posterior common hepatic artery approach (SPLD-PPPH) based on a newly defined portal triangle. The surgical outcome of the patients, as well as the efficacy and safety of SPLD-PPPH are reported.

RESULTS

A total of 51 patients were included with most of them being male (n = 34, 66.7%). According to the 8th edition of AJCC TNM staging, there were four (7.8%) patients in stage I, 13 (25.5%) in stage II, 33 (64.7%) in stage III and one (2.0%) in stage IV. The average duration for LND was about 1 h (67.7 ± 6.9 min). After surgery, four patients developed morbidities, but all were treated successfully with no perioperative mortality. Among the 51 patients included, the percentage of patients who had lymph node metastasis at station 8p was 9.8%. Of note, with a total of 14 lymph nodes harvested at station 8p, the incidence of nodal metastasis was 14.3%.

CONCLUSION

About one in 10 patients with advanced gastric cancer had nodal metastasis at station 8p. The new approach of SPLD-PPPH is safe and effective for D2+ LND during laparoscopic radical gastrectomy.

Keywords: Laparoscopic radical gastrectomy; Lymphadenectomy; Lymph node metastasis; Portal vein priority; Lymph node

Core Tip: D2 radical operation has been the standard treatment of gastric cancer. One in 10 advanced gastric cancer patients had lymph node metastasis at station 8p, but D2 lymphadenectomy (LND) remains technically difficult. The new superior pancreatic LND with portal vein priority via the posterior common hepatic artery approach achieved safe removal of 8p lymph nodes.