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Nishino M, Yoshikawa T, Yura M, Ogawa R, Sakon R, Ishizu K, Wada T, Hayashi T, Yamagata Y. Key nodal stations for predicting splenic hilar nodal metastasis in upper advanced gastric cancer without invasion of the greater curvature. Ann Gastroenterol Surg 2024; 8:413-419. [PMID: 38707232 PMCID: PMC11066481 DOI: 10.1002/ags3.12759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/26/2023] [Accepted: 11/05/2023] [Indexed: 05/07/2024] Open
Abstract
Background Standard surgery for upper advanced gastric cancer without invasion of the greater curvature (UGC-GC) is spleen-preserving D2 total gastrectomy without dissection of the splenic-hilar nodes (#10). However, some patients with nodal metastasis to #10 survive more than 5 years due to nodal dissection of #10. If nodal metastasis to #10 is predictable based on the positivity of other nodes dissected by the current standard surgery without #10 nodal dissection, physicians may be able to consider #10 dissection. Methods This study retrospectively reviewed data from the National Cancer Center Hospital in Japan between 2000 and 2012. We selected cases that met the following criteria: (1) D2 or more total gastrectomy with splenectomy, (2) UGC-GC, and (3) histological type is gastric adenocarcinoma. We performed univariate and multivariate analyses concerning lymph node stations associated with #10 metastasis. Results A total of 366 patients were examined. A multivariate analysis revealed that #10 metastasis was associated with positivity of the nodes along the short gastric arteries (#4sa) and distal nodes along the splenic artery (#11d) (#4sa: p = 0.003, #11d: p = 0.016). When either key node was positive, the metastatic rate of #10 was 24.4%, and the therapeutic value index was 13.3. Conclusions #4sa and #11d were key lymph nodes predicting #10 nodal metastasis in UGC-GC. When these key nodes are positive on computed tomography before surgery or according to a rapid pathological examination during surgery, dissection of #10 should be considered even if upper advanced tumors are not invading the greater curvature.
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Affiliation(s)
- Masashi Nishino
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Takaki Yoshikawa
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Masahiro Yura
- Department of Gastric SurgeryNational Cancer Center Hospital EastKashiwaJapan
| | - Rei Ogawa
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Ryota Sakon
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Kenichi Ishizu
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Takeyuki Wada
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Tsutomu Hayashi
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Yukinori Yamagata
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
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Kadoya S, Tsuji T, Gunjigake K, Sakimura Y, Hayashi K, Yamaguchi T, Obatake Y, Terai S, Kitamura H, Bando H. Surgical Approach to the Upper Side of the Gastrosplenic Ligament During Laparoscopic Total Gastrectomy for Proximal Gastric Cancer: Operative Techniques and Initial Results. J Laparoendosc Adv Surg Tech A 2024; 34:263-267. [PMID: 38237122 DOI: 10.1089/lap.2023.0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Background: Laparoscopic gastrectomy for gastric cancer has become widespread as minimally invasive surgical treatment, but use of laparoscopic total gastrectomy (LTG) remains limited because of the technical difficulty and complexity of lymphadenectomy at the splenic hilum. Surgical techniques and initial experiences with the surgical approach to the upper side of the gastrosplenic ligament during LTG are introduced. Materials and Methods: Between January 2019 and December 2022, 57 patients with proximal gastric cancer underwent LTG using this approach. Results: Regarding the extent of lymphadenectomy, D1+, D2, spleen-preserving D2 + 10, and D2 + 10 with splenectomy were performed in 31, 18, 4, and 4 patients, respectively. Operative time was 341 (192-724) minutes, and estimated blood loss was 30 (0-515) g. There were no conversions to laparotomy and no postoperative complications of Clavien-Dindo grade ≥III. Conclusions: The present procedure is safe and feasible and provides an excellent operative view at the splenic hilum, making it easier to determine exactly the extent of lymphadenectomy in accordance with cancer progression.
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Affiliation(s)
- Shinichi Kadoya
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Toshikatsu Tsuji
- Department of Gastrointestinal Surgery, Kanazawa University, Kanazawa, Japan
| | - Katsuya Gunjigake
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Yusuke Sakimura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kengo Hayashi
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Takahisa Yamaguchi
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Yoshinao Obatake
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Shiro Terai
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hirotaka Kitamura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Umebayashi Y, Muro S, Tokunaga M, Saito T, Sato Y, Tanioka T, Kinugasa Y, Akita K. Distribution of splenic artery lymph nodes and splenic hilar lymph nodes. World J Gastrointest Surg 2023; 15:812-824. [PMID: 37342844 PMCID: PMC10277957 DOI: 10.4240/wjgs.v15.i5.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/18/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Total gastrectomy with splenectomy is the standard treatment for advanced proximal gastric cancer with greater-curvature invasion. As an alternative to splenectomy, laparoscopic spleen-preserving splenic hilar lymph node (LN) dissection (SPSHLD) has been developed. With SPSHLD, the posterior splenic hilar LNs are left behind.
AIM To clarify the distribution of splenic hilar (No. 10) and splenic artery (No. 11p and 11d) LNs and to verify the possibility of omitting posterior LN dissection in laparoscopic SPSHLD from an anatomical standpoint.
METHODS Hematoxylin & eosin-stained specimens were prepared from six cadavers, and the distribution of LN No. 10, 11p, and 11d was evaluated. In addition, heatmaps were constructed and three-dimensional reconstructions were created to visualize the LN distribution for qualitative evaluation.
RESULTS There was little difference in the number of No. 10 LNs between the anterior and posterior sides. For LN No. 11p and 11d, the anterior LNs were more numerous than the posterior LNs in all cases. The number of posterior LNs increased toward the hilar side. Heatmaps and three-dimensional reconstructions showed that LN No. 11p was more abundant in the superficial area, while LN No. 11d and 10 were more abundant in the deep intervascular area.
CONCLUSION The number of posterior LNs increased toward the hilum and was not neglectable. Thus, surgeons should consider that some posterior No. 10 and No. 11d LNs may remain after SPSHLD.
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Affiliation(s)
- Yuya Umebayashi
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Toshifumi Saito
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Yuya Sato
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Toshiro Tanioka
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
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4
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Robb H, Scrimgeour G, Boshier P, Przedlacka A, Balyasnikova S, Brown G, Bello F, Kontovounisios C. The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review. Surg Endosc 2022; 36:5907-5920. [PMID: 35277766 PMCID: PMC9283150 DOI: 10.1007/s00464-022-09176-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/24/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND 3D reconstruction technology could revolutionise medicine. Within surgery, 3D reconstruction has a growing role in operative planning and procedures, surgical education and training as well as patient engagement. Whilst virtual and 3D printed models are already used in many surgical specialities, oesophagogastric surgery has been slow in their adoption. Therefore, the authors undertook a scoping review to clarify the current and future roles of 3D modelling in oesophagogastric surgery, highlighting gaps in the literature and implications for future research. METHODS A scoping review protocol was developed using a comprehensive search strategy based on internationally accepted guidelines and tailored for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). This is available through the Open Science Framework (osf.io/ta789) and was published in a peer-reviewed journal. Included studies underwent screening and full text review before inclusion. A thematic analysis was performed using pre-determined overarching themes: (i) surgical training and education, (ii) patient education and engagement, and (iii) operative planning and surgical practice. Where applicable, subthemes were generated. RESULTS A total of 56 papers were included. Most research was low-grade with 88% (n = 49) of publications at or below level III evidence. No randomised control trials or systematic reviews were found. Most literature (86%, n = 48) explored 3D reconstruction within operative planning. These were divided into subthemes of pre-operative (77%, n = 43) and intra-operative guidance (9%, n = 5). Few papers reported on surgical training and education (14%, n = 8), and were evenly subcategorised into virtual reality simulation (7%, n = 4) and anatomical teaching (7%, n = 4). No studies utilising 3D modelling for patient engagement and education were found. CONCLUSION The use of 3D reconstruction is in its infancy in oesophagogastric surgery. The quality of evidence is low and key themes, such as patient engagement and education, remain unexplored. Without high quality research evaluating the application and benefits of 3D modelling, oesophagogastric surgery may be left behind.
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Affiliation(s)
- Henry Robb
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Piers Boshier
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Anna Przedlacka
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Gina Brown
- Imperial College London, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Christos Kontovounisios
- Imperial College London, London, UK.
- The Royal Marsden NHS Foundation Trust, London, UK.
- Chelsea Westminster NHS Foundation Trust, London, UK.
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Akimoto E, Kinoshita T, Sato R, Yoshida M, Nishiguchi Y, Harada J. Feasibility of laparoscopic total gastrectomy with splenectomy for proximal advanced gastric cancer: A comparative study with open surgery. Asian J Endosc Surg 2021; 14:417-423. [PMID: 33145999 DOI: 10.1111/ases.12884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Total gastrectomy with splenectomy (TGS) is sometimes performed for treatment of locally advanced gastric cancer invading the greater curvature because metastasis to splenic hilar nodes is expected. Despite the widespread use of laparoscopic procedures, the feasibility of laparoscopic TGS (LTGS) has been scarcely reported because of its technical difficulties. METHODS This retrospective single-institutional study included 93 consecutive patients with proximal advanced gastric cancer who underwent either LTGS or open TGS (OTGS) from 2010 to 2018. The patients who underwent LTGS (n = 12) were compared with a 1:2 ratio propensity score-matched cohort of patients who underwent OTGS (n = 20). Clinical outcomes were retrospectively reviewed and compared between the two groups. RESULTS The patients' baseline characteristics were well balanced between the two groups. The operating time was longer (332.5 vs 222.5 minutes, P < .01) but the blood loss volume was smaller (34.5 vs 426 mL, P < .01) in the LTGS than OTGS group. The incidence of postoperative morbidity (≥ Clavien-Dindo grade III) was much lower (0.0% vs 36.8%, P = .02) and the median postoperative hospital stay was shorter (9 vs 11 days, P < .01) in the LTGS than OTGS group. The median number of harvested No. 10 or 11 days lymph nodes was equivalent between the two groups. CONCLUSIONS Although TGS is not a common procedure, LTGS may be safely performed in selected patients when carried out by an experienced surgical team. The oncological safety remains unclear and needs to be further examined in future trials.
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Affiliation(s)
- Eigo Akimoto
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takahiro Kinoshita
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Reo Sato
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Mitsumasa Yoshida
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yukiko Nishiguchi
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Junichiro Harada
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
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Evaluation of relationship between splenic artery and pancreatic parenchyma using three-dimensional computed tomography for laparoscopic distal pancreatectomy. Langenbecks Arch Surg 2021; 406:1885-1892. [PMID: 33721087 DOI: 10.1007/s00423-021-02101-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/21/2021] [Indexed: 01/06/2023]
Abstract
AIM Isolating the root of the splenic artery (SPA) is a challenging procedure in laparoscopic distal pancreatectomy (LDP). We investigated the usefulness of evaluation of the relationship between the SPA and pancreatic parenchyma using three-dimensional computed tomography (3D-CT). METHODS In total, 104 patients were evaluated. The relationship between the SPA and pancreatic parenchyma was classified into two types: buried and non-buried. Video clips of 50 patients who underwent LDP requiring isolation of the SPA root were reviewed to determine whether the classification is related to difficulty of LDP. RESULTS Of the 50 assessed patients who underwent LDP, the relationship between the SPA and pancreatic parenchyma was the buried type in 30 (60.0%) and non-buried type in 20 (40.0%). The buried type was associated with a significantly longer median operative time than the non-buried type (285.0 vs. 235.5 min, respectively; P < 0.01). The median time required to isolate the SPA in the buried type (25.8 min; range, 4.0-101 min) was significantly longer than that in the non-buried type (7.0 min; range, 1.0-27.0 min) (P < 0.001). CONCLUSION Preoperative 3D-CT around the pancreas is practical for predicting the difficulty of SPA isolation and determining the safety of the procedure.
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7
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Kinoshita T, Okayama T. Is splenic hilar lymph node dissection necessary for proximal gastric cancer surgery? Ann Gastroenterol Surg 2021; 5:173-182. [PMID: 33860137 PMCID: PMC8034691 DOI: 10.1002/ags3.12413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022] Open
Abstract
Advanced proximal gastric cancer sometimes metastasizes to the splenic hilar lymph nodes (No. 10 LN). Total gastrectomy combined with splenectomy is performed for complete removal of the No. 10 LN and was historically a standard procedure in Japan. However, splenectomy is associated with several disadvantages for patients, such as increased postoperative morbidity, risk of thrombogenic disease, fatal infection from encapsulated bacteria, and the development of other types of cancer in the long term because of loss of immune function. Therefore, splenectomy should only be performed when its estimated oncological effect exceeds such disadvantages. A Japanese randomized controlled trial (JCOG0110) clearly demonstrated that prophylactic splenectomy is not necessary unless the tumor has invaded the greater curvature; thus, splenectomy is no longer routinely performed in Japan. However, several retrospective studies have shown a comparatively high incidence of No. 10 LN metastasis and therapeutic value from LN dissection at that station in the tumors invading the greater curvature. Similar tendencies have also been reported in type 4 or remnant gastric cancer involving the greater curvature. In view of these facts, No. 10 LN dissection is presently recommended for such patients; however, robust evidence is lacking. In recent years, laparoscopic/robotic spleen-preserving splenic hilar dissection utilizing augmented visualization without pancreatic mobilization has been developed. This procedure is expected to replace prophylactic splenectomy and provide an equal oncological effect with lower morbidity. In Japan, a prospective phase-II study (JCOG1809) is currently ongoing to investigate the safety and feasibility of this procedure.
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Affiliation(s)
- Takahiro Kinoshita
- Gastric Surgery DivisionNational Cancer Center Hospital EastKashiwaJapan
| | - Takafumi Okayama
- Gastric Surgery DivisionNational Cancer Center Hospital EastKashiwaJapan
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8
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Roh CK, Lee S, Son SY, Hur H, Han SU. Risk Factors for the Severity of Complications in Minimally Invasive Total Gastrectomy for Gastric Cancer: a Retrospective Cohort Study. J Gastric Cancer 2021; 21:352-367. [PMID: 35079438 PMCID: PMC8753276 DOI: 10.5230/jgc.2021.21.e34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/21/2021] [Accepted: 11/03/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose Minimally invasive gastrectomy is a promising surgical method with well-known benefits, including reduced postoperative complications. However, for total gastrectomy of gastric cancers, this approach does not significantly reduce the risk of complications. Therefore, we aimed to evaluate the incidence and risk factors for the severity of complications associated with minimally invasive total gastrectomy for gastric cancer. Materials and Methods The study included 392 consecutive patients with gastric cancer who underwent either laparoscopic or robotic total gastrectomy between 2011 and 2019. Clinicopathological and operative characteristics were assessed to determine the features related to postoperative complications after minimally invasive total gastrectomy. Binomial and multinomial logistic regression models were used to identify the risk factors for overall complications and mild and severe complications, respectively. Results Of 103 (26.3%) patients experiencing complications, 66 (16.8%) and 37 (9.4%) developed mild and severe complications, respectively. On multivariate multinomial regression analysis, independent predictors of severe complications included obesity (OR, 2.56; 95% CI, 1.02−6.43; P=0.046), advanced stage (OR, 2.90; 95% CI, 1.13−7.43; P=0.026), and more intraoperative bleeding (OR, 1.04; 95% CI, 1.02−1.06; P=0.001). Operation time was the only independent risk factor for mild complications (OR, 1.06; 95% CI, 1.001−1.13; P=0.047). Conclusions The risk factors for mild and severe complications were associated with surgery, indicating surgical difficulty. Surgeons should be aware of these potential risks that are related to the severity of complications so as to reduce surgery-related complications after minimally invasive total gastrectomy for gastric cancer.
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Affiliation(s)
- Chul Kyu Roh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University Medical Center, Suwon, Korea
| | - Soomin Lee
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University Medical Center, Suwon, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University Medical Center, Suwon, Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University Medical Center, Suwon, Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- Gastric Cancer Center, Ajou University Medical Center, Suwon, Korea
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Kinoshita T, Sato R, Akimoto E, Yoshida M, Harada J, Nishiguchi Y. Can laparoscopic spleen-preserving splenic hilar lymph node dissection replace prophylactic splenectomy for proximal advanced gastric cancers that invade the greater curvature? Eur J Surg Oncol 2020; 47:1466-1472. [PMID: 33267998 DOI: 10.1016/j.ejso.2020.11.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/05/2020] [Accepted: 11/20/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Proximal advanced gastric cancer that invades the greater curvature is often treated by prophylactic splenectomy because of a risk for metastasis to the splenic hilar lymph node (station No.10). We evaluated whether laparoscopic spleen-preserving splenic hilar dissection (SPSHD) could be a better approach. METHODS We reviewed records of patients with proximal gastric cancer who underwent total gastrectomy with No.10 dissection between 2012 and 2018 using our in-house database set. We divided patients by whether they had received SPSHD or splenectomy, first to compare surgical outcomes, and subsequently to analyze survival outcomes among patients with tumors invading the greater curvature. RESULTS Of 145 patients enrolled in this study, 82 had SPSHDs and 63 had splenectomies. All SPSHDs were laparoscopic; 80% of splenectomies were laparotomic. Morbidity ≥ grade III was seen in 8.5% of the SPSHD group and 11.1% of the splenectomy group. The median number of retrieved No. 10 nodes was three in each group. In multivariable analysis, SPSHD was not an independent prognostic factor among patients whose tumors invaded the greater curvature (n = 73). Among propensity-matched cohorts (n = 25 each), 5-year relapse-free survival rates were 77.6% in the SPSHD group and 49.9% in the splenectomy group. CONCLUSION Laparoscopic SPSHD can potentially replace prophylactic splenectomy.
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Affiliation(s)
- Takahiro Kinoshita
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Reo Sato
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Eigo Akimoto
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Mitsumasa Yoshida
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Junichiro Harada
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yukiko Nishiguchi
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
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10
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Peng M, Liu J, Yang X, Liu S, Wu M. The Retropancreatic Fusion Fascia Oriented Splenic Hilar Lymphadenectomy Versus Laparoscopic Approach In D2 Total Gastrectomy. Med Sci Monit 2020; 26:e919003. [PMID: 32386052 PMCID: PMC7852037 DOI: 10.12659/msm.919003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The retropancreatic fusion fascia is recognized as the anatomical landmark during retropancreatic mobilization. However, its role in D2 total gastrectomy for proximal advanced gastric cancer (PAGC) remains unexplored. This study aimed to develop the retropancreatic fusion fascia-oriented ex vivo approach for splenic hilar lymphadenectomy (RP-SL) to avoid difficulty in using the total laparoscopic approach (TL-SL). MATERIAL AND METHODS The data for patients with PAGC who underwent D2 total gastrectomy were retrieved from our clinical database and electronic medical records (December 2016 to December 2018), with a 1:1 match ratio for balance of the 2 groups. RESULTS In sum, 84 matched patients were included in the study. There were 2360 retrieved lymph nodes (LNs), with an average of 28.10. Sixteen patients were confirmed with positive splenic hilar lymphadenectomy, and the mean harvested lymph nodes (LNs) were significantly increased in the RP-SL group compared to the TL-SL group (3.07 vs. 2.29, P<0.001), decreased operative time (193.21 min vs. 247.74 min, P<0.001), and less blood loss (96.90 mL vs. 185.24 mL, P=0.001) in the RP-SL group. Postoperative hospital stay (6.55 days vs. 7.26 days), rate of morbidity (9.50% vs. 11.91%), and overall costs (¥65255.64 vs. ¥64419.91) were comparable between the groups (P>0.05). CONCLUSIONS The landmark at the conjunction between the superior mesenteric vessels and the inferior pancreatic margin made it feasible to identify the retropancreatic areolar. The RP-SL approach was safe and efficient for splenic hilar lymphadenectomy.
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Affiliation(s)
- Mengyin Peng
- Department of Gastrointestinal Surgery, The Second People's Hospital of Yibin, Sichuan, Chengdu, China (mainland)
| | - Jian Liu
- Department of Gastrointestinal Surgery, The Second People's Hospital of Yibin, Sichuan, Chengdu, China (mainland)
| | - XiaoBo Yang
- Department of Gastrointestinal Surgery, The Second People's Hospital of Yibin, Sichuan, Chengdu, China (mainland)
| | - ShiChen Liu
- Department of Gastrointestinal Surgery, The Second People's Hospital of Yibin, Sichuan, Chengdu, China (mainland)
| | - Miao Wu
- Department of Gastrointestinal Surgery, The Second People's Hospital of Yibin, Sichuan, Chengdu, China (mainland)
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Murono K, Miyake H, Hojo D, Nozawa H, Kawai K, Hata K, Tanaka T, Nishikawa T, Shuno Y, Sasaki K, Kaneko M, Emoto S, Ishii H, Sonoda H, Ishihara S. Vascular anatomy of the splenic flexure, focusing on the accessory middle colic artery and vein. Colorectal Dis 2020; 22:392-398. [PMID: 31650684 DOI: 10.1111/codi.14886] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023]
Abstract
AIM Recently, the accessory middle colic artery (AMCA) has been recognized as the vessel that supplies blood to the splenic flexure. However, the positional relationship between the AMCA and inferior mesenteric vein (IMV) has not been evaluated. Herein, we aimed to evaluate the anatomy of the AMCA and the splenic flexure vein (SFV). METHOD Two hundred and five patients with colorectal cancer who underwent enhanced CT preoperatively were enrolled in the present study. The locations of the AMCA and IMV were evaluated, focusing on the positional relationship between the vessels and pancreas - below the pancreas or to the dorsal side of the pancreas. RESULTS The AMCA was observed in 74 (36.1%) patients whereas the SFV was found in 177 (86.3%) patients. The left colic artery (LCA) was the major artery accompanying the SFV in 87 (42.4%) of patients. The AMCA accompanied the SFV in 65 (32.7%) patients. In 15 (7.8%) patients, no artery accompanied the SFV. The origin of the AMCA was located on the dorsal side of the pancreas in 15 (20.3%) of these 74 patients. Similarly, the destination of the IMV was located on the dorsal side of the pancreas in 65 (31.7%) of patients. CONCLUSION The SFV was observed in most patients, and the LCA or AMCA was the common accompanying artery. In some patients these vessels were located on the dorsal side of the pancreas and not below it. Preoperative evaluation of this anatomy may be beneficial for lymph node dissection during left-sided hemicolectomy.
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Affiliation(s)
- K Murono
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - H Miyake
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - D Hojo
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - H Nozawa
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - K Kawai
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - K Hata
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - T Tanaka
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - T Nishikawa
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Y Shuno
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - K Sasaki
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - M Kaneko
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - S Emoto
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - H Ishii
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - H Sonoda
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - S Ishihara
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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12
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Diagnosis of invasion depth in resectable advanced gastric cancer for neoadjuvant chemotherapy: An exploratory analysis of Japan clinical oncology group study: JCOG1302A. Eur J Surg Oncol 2020; 46:1074-1079. [PMID: 32173178 DOI: 10.1016/j.ejso.2020.02.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/29/2020] [Accepted: 02/26/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is increasingly used for resectable locally advanced gastric cancer (LAGC). JCOG1302A investigated the diagnostic criteria of LAGC patients with cT3-4/N1-3 to minimize contamination of pathological stage I as a candidate for NAC. In JCOG1302A, 77.2% of cT3-4 tumors diagnosed via a combination of endoscopy and computed tomography (CT) were pT3-4. However, the role of endoscopic ultrasonography (EUS) and additional diagnostic procedures/modalities remains unclear. Here, we investigated whether EUS, thin-slice CT, and foaming agent (FA) in CT contribute to accurate diagnosis of AGC invasion depth. METHODS Using JCOG1302A study data, we compared positive predictive value (PPV), negative predictive value (NPV), and kappa index (KI) between conventional and additional diagnostic procedures to identify pT3-4: conventional endoscopy (CE) with versus without EUS, 1-mm versus 5-mm CT slice, and CT with versus without FA. RESULTS We analyzed 1232 patients' data. PPV, NPV, and KI were 79.2%/73.7%, 59.2%/58.8%, and 0.38/0.39 (CE alone/CE with EUS), 77.8%/75.5%, 62.9%/71.2%, and 0.38/0.39 (5-mm CT/1-mm CT), and 78.6%/75.1%, 60.9%/69.7%, and 0.38/0.40 (CT without FA/CT with FA), respectively. Overall, there were no remarkable differences in any comparison. More specifically, PPV and KI were slightly higher with CE alone rather than CE with EUS. Although NPV was higher for 1-mm CT and CT with FA, PPV was rather higher for 5-mm CT and CT without FA. CONCLUSION Additional diagnostic procedures/modalities, like EUS, 1-mm slice CT, or FA in CT may not improve the diagnostic accuracy of invasion depth in resectable LAGC.
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Guner A, Hyung WJ. Advantages of Splenic Hilar Lymph Node Dissection in Proximal Gastric Cancer Surgery. J Gastric Cancer 2020; 20:19-28. [PMID: 32269841 PMCID: PMC7105411 DOI: 10.5230/jgc.2020.20.e10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/13/2022] Open
Abstract
Gastrectomy with lymph node dissection remains the gold standard for curative treatment of gastric cancer. Dissection of splenic hilar lymph nodes has been included as a part of D2 lymph node dissection for proximal gastric cancer. Previously, pancreatico-splenectomy has been performed for dissecting splenic hilar lymph nodes, followed by pancreas-preserving splenectomy and spleen-preserving lymphadenectomy. However, the necessity of routine splenectomy or splenic hilar lymph node dissection has been under debate due to the increased morbidity caused by splenectomy and the poor prognostic feature of splenic hilar lymph node metastasis. In contrast, the relatively high incidence of splenic hilar lymph node metastasis, survival advantage, and therapeutic value of splenic hilar lymph node dissection in some patient subgroups, as well as the effective use of novel technologies, still supports the necessity and applicability of splenic hilar lymph node dissection. In this review, we aimed to evaluate the need for splenic hilar lymph node dissection and suggest the subgroup of patients with favorable outcomes.
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Affiliation(s)
- Ali Guner
- Department of General Surgery, Karadeniz Technical University College of Medicine, Trabzon, Turkey
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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14
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Toriumi T, Terashima M. Disadvantages of Complete No. 10 Lymph Node Dissection in Gastric Cancer and the Possibility of Spleen-Preserving Dissection: Review. J Gastric Cancer 2020; 20:1-18. [PMID: 32269840 PMCID: PMC7105416 DOI: 10.5230/jgc.2020.20.e8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/17/2020] [Indexed: 11/20/2022] Open
Abstract
Splenic hilar lymph node dissection has been the standard treatment for advanced proximal gastric cancer. Splenectomy is typically performed as part of this procedure. However, splenectomy has some disadvantages, such as increased risk of postoperative complications, especially pancreatic fistula. Moreover, patients who underwent splenectomy are vulnerable to potentially fatal infection caused by encapsulated bacteria. Furthermore, several studies have shown an association of splenectomy with cancer development and increased risk of thromboembolic events. Therefore, splenectomy should be avoided if it does not confer a distinct oncological advantage. Most studies that compared patients who underwent splenectomy and those who did not failed to demonstrate the efficacy of splenectomy. Based on the results of a randomized controlled trial conducted in Japan, prophylactic dissection with splenectomy is no longer recommended in patients with gastric cancer with no invasion of the greater curvature. However, patients with greater curvature invasion or those with remnant gastric cancer still need to undergo splenectomy to facilitate splenic hilar node dissection. Spleen-preserving splenic hilar node dissection is a new procedure that may help delink splenic hilar node dissection and splenectomy. In this review, we examine the evidence pertaining to the efficacy and disadvantages of splenectomy. We discuss the possibility of spleen-preserving surgery for prophylactic splenic hilar node dissection to overcome the disadvantages of splenectomy.
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Affiliation(s)
- Tetsuro Toriumi
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
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15
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Ma Z, Shi G, Chen X, Zhao S, Yang L, Ding W, Wang X. Laparoscopic splenic hilar lymph node dissection for advanced gastric cancer: to be or not to be. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:343. [PMID: 31475213 DOI: 10.21037/atm.2019.07.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The incidence of proximal gastric cancer has increased in both the East and the West. Although some novel reconstructions like double-tract or double-flap anti-reflux procedure related to proximal gastrectomy are promising, total radical gastrectomy still accounts for a significant portion of these procedures. D2 radical gastrectomy is the globally accepted standard surgical procedure for advanced gastric cancer, and lymph node (LN) dissection is considered as the critical point of radical surgery and closely related to the prognosis. The splenic hilar LNs (No. 10) are LNs that need to be removed during standard D2 surgery for proximal and total gastrectomy. Lymphadenectomy does not only provide valuable information on the prognosis of gastric cancer, but the thoroughness of the sweep itself is directly related to postoperative survival. The incidence of splenic hilar LN (No. 10) metastasis rate is not high. Although the LN metastasis pathway around the spleen is complicated, the feasibility of laparoscopic splenic hilar LN dissection in locally advanced gastric cancer has been verified. However, these results are mostly from small volume clinical studies, and the fact is that the dissection of the splenic hilar is technique-demanding even for open surgery. The rational strategy for LN dissection for surgeons is still controversial. For splenic LN dissection in radical gastric cancer surgery, whether to select individualized splenic LN dissection for those patients highly suspected of clinical metastasis or to advocate the evidence-based strategy and neglect dissection in lower risk patients to avoid over-removing of LNs, is a vital question that needs to be clarified.
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Affiliation(s)
- Zhiming Ma
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Guang Shi
- Department of Oncology & Hematology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Xin Chen
- Department of Gastroenterology and Endoscopy Center, The Second Hospital of Jilin University, Changchun 130041, China
| | - Shutao Zhao
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Longfei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun 130041, China
| | - Wei Ding
- Department of Thyroid Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Xudong Wang
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun 130041, China
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16
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Ishikawa Y, Ban D, Watanabe S, Akahoshi K, Ono H, Mitsunori Y, Kudo A, Tanaka S, Tanabe M. Splenic artery as a simple landmark indicating difficulty during laparoscopic distal pancreatectomy. Asian J Endosc Surg 2019; 12:81-87. [PMID: 29656597 DOI: 10.1111/ases.12485] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 02/17/2018] [Accepted: 02/26/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The use of laparoscopic distal pancreatectomy (LDP) is increasing worldwide. It is important for surgeons to predict preoperatively the difficulty and risks of a surgery. However, very few reports have evaluated the impact of patient or tumor factors on the difficulty of LDP. We aimed to determine the predictors of technical difficulties when performing LDP. METHODS This study included 34 patients who underwent LDP. Patient information was obtained retrospectively and included age, gender, BMI, primary disease, previous abdominal surgery, previous pancreatitis, tumor size, tumor proximity to the splenic arterial origin, type of splenic artery (SpA), operative time, blood loss, postoperative pancreatic fistula, and length of hospital stay. Univariate and multivariate analyses were performed to determine the predictors of a long operative time. SpA anatomy was classified into two types based on the relationship between its origin and the pancreas. Patients whose SpA origin was upward of the pancreatic parenchyma were classified as SpA type 1, whereas patients whose SpA origin was covered by the pancreatic parenchyma were classified as SpA type 2. RESULTS Multivariate analysis revealed SpA type 2 to be an independent risk factor for a long operation (odds ratio = 9.925; 95% confidence interval: 1.461-67.412; P = 0.019). SpA type 2 was related to a longer operative time (P < 0.001) and greater intraoperative blood loss (P = 0.001). CONCLUSION Classification according to SpA type is simple and useful for predicting technical difficulty when performing LDP.
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Affiliation(s)
- Yoshiya Ishikawa
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuichi Watanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akahoshi
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroaki Ono
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Mitsunori
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Kudo
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinji Tanaka
- Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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17
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Kawaguchi Y, Shiraishi K, Akaike H, Ichikawa D. Current status of laparoscopic total gastrectomy. Ann Gastroenterol Surg 2019; 3:14-23. [PMID: 30697606 PMCID: PMC6345655 DOI: 10.1002/ags3.12208] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/12/2018] [Accepted: 08/14/2018] [Indexed: 12/13/2022] Open
Abstract
In this article, the current state of laparoscopic total gastrectomy (LTG) was reviewed, focusing on lymph node dissection and reconstruction. Lymph node dissection in LTG is technically similar to that in laparoscopic distal gastrectomy for early gastric cancer; however, LTG for advanced gastric cancer requires extended lymph node dissections including splenic hilar lymph nodes. Although a recent randomized controlled trial clearly indicated no survival benefit in prophylactic splenectomy for lymph node dissection at the splenic hilum, some patients may receive prognostic benefit from adequate splenic hilar lymph node dissection. Considering reconstruction, there are two major esophagojejunostomy (EJS) techniques, using a circular stapler (CS) or using a linear stapler (LS). A few studies have shown that the LS method has fewer complications; however, almost all studies have reported that morbidity (such as anastomotic leakage and stricture) is not significantly different for the two methods. As for CS, we grouped various studies addressing complications in LTG into categories according to the insertion procedure of the anvil and the insertion site in the abdominal wall for the CS. We compared the rate of complications, particularly for leakage and stricture. The rate of anastomotic leakage and stricture was the lowest when inserting the CS from the upper left abdomen and was significantly the highest when inserting the CS from the midline umbilical. Scrupulous attention to EJS techniques is required by surgeons with a clear understanding of the advantages and disadvantages of each anastomotic device and approach.
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Affiliation(s)
- Yoshihiko Kawaguchi
- First Department of SurgeryFaculty of MedicineUniversity of YamanashiChuoYamanashiJapan
| | - Kensuke Shiraishi
- First Department of SurgeryFaculty of MedicineUniversity of YamanashiChuoYamanashiJapan
| | - Hidenori Akaike
- First Department of SurgeryFaculty of MedicineUniversity of YamanashiChuoYamanashiJapan
| | - Daisuke Ichikawa
- First Department of SurgeryFaculty of MedicineUniversity of YamanashiChuoYamanashiJapan
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18
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Ishikawa Y, Ehara K, Yamada T, Matsuzawa N, Arai S, Ban D, Kudo A, Tanabe M, Kawashima Y, Sakamoto H. Three-dimensional computed tomography analysis of the vascular anatomy of the splenic hilum for gastric cancer surgery. Surg Today 2018; 48:841-847. [DOI: 10.1007/s00595-018-1679-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/30/2018] [Indexed: 01/20/2023]
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19
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Training for laparoscopic pancreaticoduodenectomy. Surg Today 2018; 49:103-107. [DOI: 10.1007/s00595-018-1668-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/27/2018] [Indexed: 12/16/2022]
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20
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Takeda A, Koike W, Watanabe K. Multimodal imaging for diagnosis and management of parasitic peritoneal myoma with myxoid degeneration after laparoscopic-assisted myomectomy with electric power morcellation. J Obstet Gynaecol Res 2018. [DOI: 10.1111/jog.13621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology; Gifu Prefectural Tajimi Hospital; Tajimi Japan
| | - Wataru Koike
- Department of Diagnostic Radiology; Gifu Prefectural Tajimi Hospital; Tajimi Japan
| | - Kazuko Watanabe
- Department of Pathology; Gifu Prefectural Tajimi Hospital; Tajimi Japan
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21
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Sunagawa H, Kinoshita T. Three-dimensional computed tomography simulation for laparoscopic lymph node dissection in the treatment of proximal gastric cancer. Transl Gastroenterol Hepatol 2017; 2:54. [PMID: 28616609 DOI: 10.21037/tgh.2017.04.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/07/2017] [Indexed: 11/06/2022] Open
Abstract
Application of laparoscopic surgery (LS) has expanded worldwide in the various fields due to the potential advantage of being less invasive than open surgery; however difficulty in recognizing positional relationship of the organs is one of the disadvantages of this kind of surgery. In order to compensate this drawback, preoperative three-dimensional computed tomography (3D-CT) simulation is regarded as promising. In gastric cancer surgery, 3D-CT simulation seems particularly effective in the splenic hilar dissection, because this region is associated with remarkable anatomical variation with complexity. As effects from the use of 3D-CT simulation, reduction of blood loss or complication rate, shortening of operation time and enhancement of surgical quality are expected. In this article, we introduce our methodological protocol of 3D-CT simulation in gastric cancer surgery with clinical case examples, and also additionally review previous publications reporting this imaging technology.
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Affiliation(s)
- Hideki Sunagawa
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takahiro Kinoshita
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
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22
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Kinoshita T, Kaito A. Current status and future perspectives of laparoscopic radical surgery for advanced gastric cancer. Transl Gastroenterol Hepatol 2017; 2:43. [PMID: 28616599 DOI: 10.21037/tgh.2017.04.05] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/07/2017] [Indexed: 12/23/2022] Open
Abstract
Laparoscopic radical gastrectomy with lymph node dissection has widely penetrated to East Asian countries, where incidence of gastric cancer occurrence is higher than the rest of the world. Laparoscopic distal gastrectomy for cStageI disease is regarded as one of the option in daily practice in the latest Japanese guidelines; however its applicability to more advanced disease (Stage II/III) is still under debate. Actually, operative techniques of laparoscopic D2 dissection is being matured, but still, necessity of total omentectomy, splenic hilar dissection, management of bulky nodes or large primary tumor, high-level anastomosis in esophageal invasion cases, and extensive peritoneal lavage can be raised as technical limitations. In the future perspective, further technological innovation, including next generation surgical robot, may help surgeons overcome these difficulties. Currently, three large-scaled randomized phase-III clinical trials are ongoing in East Asia, in which patients' accruals have been already completed. With coming long-term outcomes of these well-designed studies, oncological validity of laparoscopic approach will be adequately elucidated.
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Affiliation(s)
- Takahiro Kinoshita
- Gastric Surgery Division, National Cancer Center Hospital East, Chiba, Japan
| | - Akio Kaito
- Gastric Surgery Division, National Cancer Center Hospital East, Chiba, Japan
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23
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Wang Z, Qi L, Yuan P, Zu X, Chen W, Cao Z, Li Y, Wang L. Application of Three-Dimensional Visualization Technology in Laparoscopic Partial Nephrectomy of Renal Tumor: A Comparative Study. J Laparoendosc Adv Surg Tech A 2017; 27:516-523. [PMID: 28186431 DOI: 10.1089/lap.2016.0645] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To compare the effectiveness and safety of individualized three-dimensional visualization technology (3DVT) on surgical planning and perioperative outcomes in laparoscopic partial nephrectomy (LPN) for renal cell carcinoma (RCC) with routine computed tomography (CT) examination in the treatment of renal tumor. METHODS From May 2015 to March 2016, a total of 94 patients with cT1 RCC who underwent surgical treatment in our department were analyzed retrospectively. Among these patients, a total of 49 cases received LPN with operation plan based on 3DVT. Surgical plan was obtained by virtual operation and morphometry on 3D reconstruction model. The remaining 45 cases received surgical treatment with traditional CT examination. Patient demographic, surgical outcome, and postoperative parameters were compared between these two groups. RESULTS No significant difference was found in blood loss volume, postoperative complication, selective clamping success rate, changes in postoperative renal function, and operative and ischemic time between the two groups. However, when handling complicated tumor with R.E.N.A.L score ≥8, operation time (126.7 ± 36.4 versus 154.8 ± 34.7, P = .018) and occurrence of postoperative urinary leak (0 versus 4, 0% versus 22.2%, P = .033) were diminished significantly in the 3DVT group. CONCLUSIONS 3DVT provided precise information of anatomical structure in the operative area and reliable guidance for preoperative plan design. Our results indicated that 3DVT facilitated accurate visible image-guided tumor resection with ideal renal function preservation in LPN for renal tumor of high complexity.
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Affiliation(s)
- Zhi Wang
- 1 Department of Urology, Xiangya Hospital, Central South University , Changsha, P.R. China
| | - Lin Qi
- 1 Department of Urology, Xiangya Hospital, Central South University , Changsha, P.R. China
| | - Peng Yuan
- 1 Department of Urology, Xiangya Hospital, Central South University , Changsha, P.R. China
| | - Xiongbing Zu
- 1 Department of Urology, Xiangya Hospital, Central South University , Changsha, P.R. China
| | - Wei Chen
- 2 Department of Radiology, Xiangya Hospital, Central South University , Changsha, P.R. China
| | - Zhenzhen Cao
- 3 Department of Gynecologic Oncology, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya Medical School, Central South University , Changsha, P.R. China
| | - Yuan Li
- 1 Department of Urology, Xiangya Hospital, Central South University , Changsha, P.R. China
| | - Long Wang
- 1 Department of Urology, Xiangya Hospital, Central South University , Changsha, P.R. China
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Kinoshita T. Splenic hilar dissection in the treatment of proximal advanced gastric cancer: what is an adequate strategy? Transl Gastroenterol Hepatol 2016; 1:72. [PMID: 28138638 DOI: 10.21037/tgh.2016.09.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 01/01/2023] Open
Affiliation(s)
- Takahiro Kinoshita
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
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Hosogi H, Okabe H, Shinohara H, Tsunoda S, Hisamori S, Sakai Y. Laparoscopic splenic hilar lymphadenectomy for advanced gastric cancer. Transl Gastroenterol Hepatol 2016; 1:30. [PMID: 28138597 DOI: 10.21037/tgh.2016.03.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/16/2016] [Indexed: 12/23/2022] Open
Abstract
Laparoscopic distal gastrectomy has recently become accepted as a surgical option for early gastric cancer in the distal stomach, but laparoscopic total gastrectomy (LTG) has not become widespread because of technical difficulties of esophagojejunal anastomosis and splenic hilar lymphadenectomy. Splenic hilar lymphadenectomy should be employed in the treatment of advanced proximal gastric cancer to complete D2 dissection, but laparoscopically it is technically difficult even for skilled surgeons. Based on the evidence that prophylactic combined resection of spleen in total gastrectomy increased the risk of postoperative morbidity with no survival impact, surgeons have preferred laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) for advanced tumors without metastasis to splenic hilar nodes or invasion to the greater curvature of the stomach, and reports with LSPL have been increasing rather than LTG with splenectomy. In this paper, recent reports with laparoscopic splenic hilar lymphadenectomy were reviewed.
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Affiliation(s)
- Hisahiro Hosogi
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Hiroshi Okabe
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan;; Department of Surgery, Otsu Municipal Hospital, Shiga 520-0804, Japan
| | - Hisashi Shinohara
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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