Abstract: Objective:To investigate the application value of vessel-guided lymph node dissection (LND) in the laparoscopic distal gastrectomy (D₂) of distal gastric cancer.
Methods:The retrospective cross-sectional study was conducted. The clinicopathological data of 157 patients who underwent laparoscopic distal gastrectomy (D₂) of distal gastric cancer in the Affiliated Tumor Hospital of Shanxi Medical University from October 2012 to July 2015 were collected. Patients used vessel-guided LND that was divided into 4 steps: middle colic vessel-guided LND in the upper pyloric region, gastroduodenal artery-guided LND in the lower pyloric region, common hepatic artery-guided LND in the right upper margin of pancreas and splenic artery-guided LND in the left upper margin of pancreas. Observation indicators: (1) surgical and intraoperative situations, (2) postoperative pathological results, (3) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative 3-year survival rate up to June 2017. Measurement data with normal distribution were represented as ±s. The survival rate was calculated using the Kaplan-Meier method.
Results: (1) Surgical and intraoperative situations: 157 patients underwent successful laparoscopic distal gastrectomy (D₂) of distal gastric cancer. Operation time, LND time, volume of intraoperative blood loss, time for initial out-of-bed activity, time to initial anal exsufflation and time of postoperative abdominal drainage-tube removal were (178±38)minutes, (61±27)minutes, (87±40)mL, (1.2±0.4)days, (2.8±1.3)days and (7.5±2.6)days, respectively. Of 157 patients, 10 with postoperative complications were improved by conservative treatment, including 5 with intestinal obstruction, 3 with anastomotic fistula and 2 dying of pulmonary infection; other patients didn′t have complications. Duration of hospital stay of 157 patients was (9±3)days. (2) Postoperative pathological results: total number of LND, numbers of LND in the lower pyloric region and in the upper margin of pancreas were 34.6±11.0, 4.8±2.1 and 12.3±4.7, respectively. TNM staging: 26, 33, 18, 24, 37 and 19 patients were respectively detected in stageⅠa, Ⅰb, Ⅱa, Ⅱb, Ⅲa and Ⅲb. (3) Follow-up situations: 142 of 157 patients were followed up for 6-56 months, with a median time of 27 months, and postoperative 3-year survival rate was 67.6%.
Conclusion:The vessel-guided LND is safe and effective in the laparoscopic distal gastrectomy (D₂) of distal gastric cancer, and the operation steps can be simplified.