A three-step method for modular lymphadenectomy in gastric cancer surgery: The ability to retrieve sufficient lymph nodes and improve survival

Modular approach in OPHL: are there preoperative predictors?

Objective

Open partial horizontal laryngectomies (OPHLs) nowadays represent the first line surgical choice for the conservative treatment of locally intermediate and selected advanced stage laryngeal cancers. Among the peculiarities of OPHLs, there is the possibility of intraoperatively modulating the procedure. It would be useful for the surgeon to recognise preoperative endoscopic and radiological factors that can predict the possibility to modulate the laryngectomy.

Methods

The present study retrospectively reviewed a cohort of 72 patients who underwent OPHL for glottic LSCC, in order to identify preoperative (endoscopic and radiological) parameters that are able to predict modulation surgery.

Results

The hypoglottic extension of the glottic tumour was the preoperative finding that was most informative in predicting OPHL modulation. However, it had no significant impact on oncological outcomes.

Conclusions

Patients affected by tumours with hypoglottic extension and eligible for OPHL type II should be preoperatively informed about the possibility of an intraoperative switch towards OPHL type III.

Complete mesogastric excision for locally advanced gastric cancer: short-term outcomes of a randomized clinical trial

Implementation of complete mesogastric excision in gastric cancer surgery, named D2 lymphadenectomy plus complete mesogastric excision (D2+CME), has recently been proposed as an optimal procedure. However, the safety and efficacy of D2+CME remain uncertain. In this randomized controlled trial, patients receiving D2+CME exhibit less intraoperative blood loss, more lymph node harvesting, and earlier postoperative flatus than patients receiving conventional D2 radical surgery. Univariate Cox regression analysis reveals that the risk ratio for postoperative flatus in D2+CME group is 1.247 (p = 0.044). Overall postoperative complications are comparable between the two groups, but complications are significantly less severe in the D2+CME group than the D2 group (Clavien-Dindo classification grade ≥ IIIa: 4 D2+CME patients [11.8%] versus 9 D2 patients [33.3%]; p = 0.041). In conclusion, our work shows that D2+CME is associated with better short-term outcomes and surgical safety than conventional D2 dissection for patients with advanced gastric cancer.

Gastric cancer patients receiving D2+CME exhibit less intraoperative blood loss

The number of lymph nodes harvested with D2+CME is significantly improved

D2+CME surgery could provide faster postoperative flatus

D2+CME is less likely to cause severe complications than conventional surgery

Modularized laparoscopic regional en bloc mesogastrium excision (rEME) based on membrane anatomy for distal gastric cancer

Background

The purpose of the study was to evaluate the safety and feasibility of a new surgical procedure named modularized laparoscopic regional En bloc mesogastrium excision (rEME) based on the membrane anatomy in distal laparoscopic radical gastrectomy for gastric cancer.

Methods

From January 2014 to June 2017, 92 consecutive cases of patients with stages I–III distal gastric cancer were divided into 2 groups: laparoscopic radical gastrectomy plus standard D₂ lymph node dissection (SD group, n = 44) and modularized rEME (rEME group, n = 48). Evaluations were made in terms of the operative data, pathological results, recovery time of digestive tract functions, complications, and length of stay.

Results

85 patients (SD group, n = 40 and rEME group, n = 45) were finally included for analysis. There were no significant differences in the median total numbers of dissected LNs (31.98 ± 10.48 vs. 34.93 ± 13.12, p = 0.261), LNs in the greater curvature (12.18 ± 6.55 vs. 13.62 ± 8.09, p = 0.444), LNs in the lesser curvature (19.55 ± 7.40 vs. 17.98 ± 8.31, p = 0.365) between the SD and rEME groups. The rEME group showed lower loss of blood volume (107.11 ± 60.13 ml vs. 146.25 ± 85.78 ml, p = 0.019). No significant differences were found in recovery time of digestive tract functions, postoperative complication rates and length of hospital stay between the two groups.

Conclusion

Laparoscopic radical gastrectomy plus modularized rEME based on the membrane anatomy is a safe and feasible procedure for distal gastric cancer.