Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan.
Ann Surg Oncol. 2017 Sep;24(9):2727. doi: 10.1245/s10434-017-5877-4. Epub 2017 May 15.
Recent technical improvements allow safe laparoscopic lymph node dissection (LND) in gastric cancer.1 2 In suprapancreatic LND, careful LND around the celiac artery (CA) is essential. From a patient's right side, deep LND is performed around the right side of the CA after dissecting around the common hepatic artery (CHA). For LND around the left side of the CA on the same operative axis as the right side, we developed a new procedure for LND along the proximal splenic artery (SA), performed from the patient's left side.
After LND around the CHA and right side of the CA from the patient's right side, the surgeon then moves to the patient's left side. The anterior pancreatic fascia is cut at the middle point of the SA to discern the dorsal layer of the LN along the SA, such as the splenic vein. LND is performed by preserving the posterior pancreatic fascia around the SA in a left-to-right direction. Finally, the LNs around the left side of the CA are deeply dissected.
We performed this procedure on ten patients between April 2016 and January 2017; no operative complications were reported in grade II or higher cancer patients.3 After exposing the dorsal landmark, LNs around the proximal SA and left side of the CA were removed in all patients.
This procedure enables early identification of the dorsal layer and deep LND around the left side of the CA, keeping this layer. The left lateral approach is useful for radical LND along the proximal SA.
最近的技术进步使得在胃癌中进行安全的腹腔镜淋巴结清扫（LND）成为可能。1 2 在胰腺上 LND 中，围绕腹腔动脉（CA）进行仔细的 LND 至关重要。从患者的右侧，在解剖肝总动脉（CHA）周围后，在 CA 的右侧进行深部 LND。对于与右侧在同一手术轴上的 CA 左侧周围的 LND，我们开发了一种从患者左侧进行的沿着脾动脉（SA）近端进行 LND 的新程序。
在从患者右侧进行 CHA 和 CA 右侧周围的 LND 后，外科医生移至患者的左侧。在 SA 的中点切开胰前筋膜，以辨别沿着 SA 的 LN 的背层，例如脾静脉。通过在从左到右的方向上围绕 SA 保留后胰腺筋膜来进行 LND。最后，深入解剖 CA 左侧周围的 LN。
我们在 2016 年 4 月至 2017 年 1 月之间对 10 名患者进行了此程序；在 II 级或更高等级的癌症患者中，没有报告手术并发症。3 在暴露背标后，所有患者均切除了近端 SA 和 CA 左侧周围的 LN。
该程序可早期识别 SA 近端和 CA 左侧周围的背层并进行深部 LND，保留该层。左侧外侧入路可用于沿着近端 SA 进行根治性 LND。
