Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Ann Surg Oncol. 2017 Oct;24(11):3331-3337. doi: 10.1245/s10434-017-5974-4. Epub 2017 Jul 11.
In radical operations for gastric cancer, a balance between the quality of lymph node dissection and safety of surgery must be ensured. During suprapancreatic lymphadenectomy in laparoscopic gastrectomy (LG), an adequate operative field should be safely and effectively established to reduce pancreas-related complications. We present a novel approach that avoids direct compression of the pancreas in LG and describe the surgical outcomes of this method.
We historically compressed the pancreas during suprapancreatic lymph node dissection in LG to obtain an adequate operative field but have since modified our operative technique. In our new method introduced in March 2016, the operative field is established by pulling and controlling the connective tissues along the inferior border of the pancreas and the nerves along the common hepatic and splenic arteries, instead of directly compressing the pancreas itself. We compared 51 patients in the compression group (January 2015-February 2016) and 45 patients in the compressionless group (March 2016-January 2017) in terms of surgical outcomes, including the amylase concentration in the drainage fluid and postoperative complications.
The amylase concentrations in the compressionless group were significantly lower on postoperative days 1 and 3 (p < 0.001 and p = 0.013, respectively) compared with the compression group. The rates of severe postoperative pancreatic fistula and intra-abdominal infectious complications decreased from 11.8 to 2.2% (p = 0.116) and from 17.6 and 2.2% (p = 0.018), respectively.
Our approach, termed "pancreas-compressionless gastrectomy," can be considered a safe and useful method to prevent postoperative infectious complications in LG.
在胃癌根治性手术中，必须在淋巴结清扫质量和手术安全性之间取得平衡。在腹腔镜胃切除术中进行胰上淋巴结清扫时，需要安全有效地建立足够的手术视野，以减少与胰腺相关的并发症。我们提出了一种新的方法，避免了腹腔镜胃切除术中胰腺的直接压迫，并描述了这种方法的手术结果。
我们在腹腔镜胃切除术中的胰上淋巴结清扫过程中曾对胰腺进行过压迫以获得足够的手术视野，但后来修改了我们的手术技术。在 2016 年 3 月引入的新方法中，通过牵拉和控制胰腺下沿和沿肝总动脉和脾动脉的神经周围的结缔组织来建立手术视野，而不是直接压迫胰腺本身。我们比较了 51 例在压迫组（2015 年 1 月至 2016 年 2 月）和 45 例无压迫组（2016 年 3 月至 2017 年 1 月）的手术结果，包括引流液中淀粉酶浓度和术后并发症。
与压迫组相比，无压迫组术后第 1 天和第 3 天的淀粉酶浓度明显降低（p<0.001 和 p=0.013）。严重的术后胰瘘和腹腔内感染性并发症的发生率从 11.8%降至 2.2%（p=0.116），从 17.6%降至 2.2%（p=0.018）。
我们的方法，称为“无胰腺压迫胃切除术”，可以被认为是预防腹腔镜胃切除术后感染性并发症的一种安全有效的方法。
