- Email: [email protected]
“Five-step” laparoscopic lymph node dissection for remnant gastric cancer following Billroth-II gastrectomy: A safe and feasible procedure
Surgical Oncology 32 (2020) 115–116
Contents lists available at ScienceDirect
Surgical Oncology journal homepage: www.elsevier.com/locate/suronc
“Five-step” laparoscopic lymph node dissection for remnant gastric cancer following Billroth-II gastrectomy: A safe and feasible procedure
T
Zhi-Fang Zhenga,b,1, Jun Lua,b,c,d,1, Chao-Hui Zhenga,b,c,d, Chang-Ming Huanga,b,c,d,∗ a
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China c Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China d Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China b
ARTICLE INFO
ABSTRACT
Keywords: Remnant gastric cancer Laparoscopy Lymph node dissection
Background: Laparoscopic surgery (LS) for remnant gastric cancer (RGC) is gaining interest [1–3]. However, due to adhesions to adjacent organs, displacement of anatomical structures, and changes in lymphatic flow triangulation, LS for RGC is considered challenging. In this study, we report our experience performing laparoscopic lymph node dissection for RGC following Billroth-II gastrectomy. Methods: The procedure was separated into five steps: (1) exploration and separation of adhesions and the greater omentum; (2) dissection of the lymph nodes (LNs) in the suprapancreatic area; (3) exposing the right side of the esophagus; (4) exposing the left gastroepiploic vessels and dissection of the LNs in the splenic hilar area; and (5) exposing the left side of the esophagus. The above procedure was performed for 45 RGC patients with stage cT1-4aN0/+ disease from January 2008 to June 2017. Results: There were no conversions to open surgery. The mean operation time was 195.0 ± 52.5 min, the mean blood loss was 104.3 ± 90.4 ml, and the mean times to first flatus, fluid diet, and soft diet were 3.6 ± 1.1 days, 4.5 ± 1.4 days, and 9.0 ± 5.1 days, respectively. A mean of 19.8 ± 12.7 LNs were retrieved. The overall postoperative morbidity rate, major postoperative morbidity [4] rate and mortality rate were 22.2%, 11.1%, and 0%, respectively. At a median follow-up of 47 months, the cumulative 3-year overall survival rate was 56.8%. Conclusions: This novel “five-step” laparoscopic lymph node dissection approach was technically safe and feasible in RGC patients following Billroth-II gastrectomy.
Funding
Acknowledgement
This work was supported by the Scientific and technological innovation joint capital projects of Fujian Province (2016Y9031), construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171), the second batch of special support funds for Fujian Province Innovation and Entrepreneurship Talents (2016B013) and QIHANG funds of Fujian Medical University (No.2016QH025).
The authors express special thanks to Ms. Jessica Giannasi for her narration of video.
Disclosures All authors declare no conflicts of interest.
Appendix A. Supplementary data Supplementary data to this article can be found online at https:// doi.org/10.1016/j.suronc.2019.09.007. References [1] H. Yamada, K. Kojima, T. Yamashita, T. Kawano, K. Sugihara, Z. Nihei, Laparoscopyassisted resection of gastric remnant cancer, Surg. Laparosc. Endosc. Percutaneous
Corresponding author. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian Province, China. E-mail address: [email protected] (C.-M. Huang). 1 Zheng ZF and Lu J contributed equally to this work and should be considered co-first authors. ∗
https://doi.org/10.1016/j.suronc.2019.09.007 Received 20 October 2018; Received in revised form 23 July 2019; Accepted 13 September 2019 0960-7404
Surgical Oncology 32 (2020) 115–116
Z.-F. Zheng, et al. Tech. 15 (2005) 226–229. [2] E. Nagai, K. Nakata, K. Ohuchida, Y. Miyasaka, S. Shimizu, M. Tanaka, Laparoscopic total gastrectomy for remnant gastric cancer: feasibility study, Surg. Endosc. 28 (2014) 289–296. [3] S.Y. Son, C.M. Lee, D.H. Jung, J.H. Lee, S.H. Ahn, J. Park do, H.H. Kim, Laparoscopic
completion total gastrectomy for remnant gastric cancer: a single-institution experience, Gastric Cancer 18 (2015) 177–182. [4] D. Dindo, N. Demartines, P.A. Clavien, Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey, Ann. Surg. 2 (2004) 205–213.
116
Contents lists available at ScienceDirect
Surgical Oncology journal homepage: www.elsevier.com/locate/suronc
“Five-step” laparoscopic lymph node dissection for remnant gastric cancer following Billroth-II gastrectomy: A safe and feasible procedure
T
Zhi-Fang Zhenga,b,1, Jun Lua,b,c,d,1, Chao-Hui Zhenga,b,c,d, Chang-Ming Huanga,b,c,d,∗ a
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China c Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China d Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China b
ARTICLE INFO
ABSTRACT
Keywords: Remnant gastric cancer Laparoscopy Lymph node dissection
Background: Laparoscopic surgery (LS) for remnant gastric cancer (RGC) is gaining interest [1–3]. However, due to adhesions to adjacent organs, displacement of anatomical structures, and changes in lymphatic flow triangulation, LS for RGC is considered challenging. In this study, we report our experience performing laparoscopic lymph node dissection for RGC following Billroth-II gastrectomy. Methods: The procedure was separated into five steps: (1) exploration and separation of adhesions and the greater omentum; (2) dissection of the lymph nodes (LNs) in the suprapancreatic area; (3) exposing the right side of the esophagus; (4) exposing the left gastroepiploic vessels and dissection of the LNs in the splenic hilar area; and (5) exposing the left side of the esophagus. The above procedure was performed for 45 RGC patients with stage cT1-4aN0/+ disease from January 2008 to June 2017. Results: There were no conversions to open surgery. The mean operation time was 195.0 ± 52.5 min, the mean blood loss was 104.3 ± 90.4 ml, and the mean times to first flatus, fluid diet, and soft diet were 3.6 ± 1.1 days, 4.5 ± 1.4 days, and 9.0 ± 5.1 days, respectively. A mean of 19.8 ± 12.7 LNs were retrieved. The overall postoperative morbidity rate, major postoperative morbidity [4] rate and mortality rate were 22.2%, 11.1%, and 0%, respectively. At a median follow-up of 47 months, the cumulative 3-year overall survival rate was 56.8%. Conclusions: This novel “five-step” laparoscopic lymph node dissection approach was technically safe and feasible in RGC patients following Billroth-II gastrectomy.
Funding
Acknowledgement
This work was supported by the Scientific and technological innovation joint capital projects of Fujian Province (2016Y9031), construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171), the second batch of special support funds for Fujian Province Innovation and Entrepreneurship Talents (2016B013) and QIHANG funds of Fujian Medical University (No.2016QH025).
The authors express special thanks to Ms. Jessica Giannasi for her narration of video.
Disclosures All authors declare no conflicts of interest.
Appendix A. Supplementary data Supplementary data to this article can be found online at https:// doi.org/10.1016/j.suronc.2019.09.007. References [1] H. Yamada, K. Kojima, T. Yamashita, T. Kawano, K. Sugihara, Z. Nihei, Laparoscopyassisted resection of gastric remnant cancer, Surg. Laparosc. Endosc. Percutaneous
Corresponding author. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian Province, China. E-mail address: [email protected] (C.-M. Huang). 1 Zheng ZF and Lu J contributed equally to this work and should be considered co-first authors. ∗
https://doi.org/10.1016/j.suronc.2019.09.007 Received 20 October 2018; Received in revised form 23 July 2019; Accepted 13 September 2019 0960-7404
Surgical Oncology 32 (2020) 115–116
Z.-F. Zheng, et al. Tech. 15 (2005) 226–229. [2] E. Nagai, K. Nakata, K. Ohuchida, Y. Miyasaka, S. Shimizu, M. Tanaka, Laparoscopic total gastrectomy for remnant gastric cancer: feasibility study, Surg. Endosc. 28 (2014) 289–296. [3] S.Y. Son, C.M. Lee, D.H. Jung, J.H. Lee, S.H. Ahn, J. Park do, H.H. Kim, Laparoscopic
completion total gastrectomy for remnant gastric cancer: a single-institution experience, Gastric Cancer 18 (2015) 177–182. [4] D. Dindo, N. Demartines, P.A. Clavien, Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey, Ann. Surg. 2 (2004) 205–213.
116