V-shaped lymph node dissection in laparoscopic distal gastrectomy; new technique of intra-abdominal dissection and surgical outcomes

Upper lesser curvature skeletonization in radical distal gastrectomy

BACKGROUND

To investigate the metastatic status of lymph nodes numbers (no.) 1, 3a, and 3b groups in radical distal gastrectomy with upper lesser curvature skeletonization and the risk factors for lesser curvature regional node (LCRN) metastasis.

METHODS

Data on patients who underwent radical distal gastrectomy were retrospectively collected between May 2010 and September 2013. Clinicopathologic features and surgical outcomes were compared between the LCRN (+) and (-) groups. The correlations among the no. 1, 3a and 3b groups, and other groups were analyzed. Univariate and multivariate analyses were performed to identify the independent risk factors for LCRN metastasis.

RESULTS

A total of 112 patients were analyzed. In all, 45.5% had metastatic LCRNs, and 59.8% were node positive overall. The LCRN (+) and (-) groups had significantly different features, including gender; tumor size; histologic grade; Lauren classification; gross type; and T, N, and TNM stages. The positivity rates of the no. 1, 3a, and 3b groups were 4.5%, 38.4%, and 32.1%, respectively, and the no. 1, 3a, and 3b groups were comprehensively correlated with the D2-tier groups. In the univariate and multivariate analyses, only stage T3-4 and positive no. 4d nodes were documented as independent risk factors, whereas no. 5 and 11p nodes trended toward a positive correlation.

CONCLUSIONS

LCRNs have high frequencies of metastasis in lower gastric cancers, and in the present study, these groups of lymph nodes tended to be associated with each other as an entity in the lesser curvature region. Upper lesser curvature skeletonization can be recommended as a standard procedure in radical distal gastrectomy to thoroughly clear the gastric stump, especially in the case of stage T3-4 or suspicious no. 4d nodes.

Effect of early oral feeding on short-term outcome of patients receiving laparoscopic distal gastrectomy: a retrospective cohort study

BACKGROUND

To evaluate the effect of early oral feeding on postoperative short-term outcome of gastric cancer patients receiving laparoscopic distal gastrectomy.

METHODS

From Oct 1, 2011 to Mar 1, 2013, 84 consecutive patients with gastric cancer were involved in this retrospective study. Patients received either early oral feeding (early feeding group) or not (control group) after laparoscopic distal gastrectomy. Details concerning the postoperative outcomes and the quality of life questionnaires were collected and compared.

RESULTS

Totally 40 patients were involved in the early feeding group and 44 in the control group. Demographic data were comparable in both groups. The duration of hospital stay (6.28 ± 1.26 VS 7.69 ± 1.53, P = 0.048) and time until flatus (2.06 ± 1.47 VS 3.56 ± 1.04, P = 0.044) in early feeding group were significantly less than that in control group. Furthermore, the score of fatigue scale in early feeding group on the seventh postoperative day was significantly less than that in control group (33.9 ± 12.1 VS 45.1 ± 10.7, P = 0.041).

CONCLUSIONS

Early oral feeding could lead to a significant improvement of the short-term benefits for patients receiving laparoscopic distal gastrectomy.