Pan Guofeng, Guo Zhixing, Huang Likui, Zhang Weihong, Li Suping, Chen Jian, Wu Jihuang, Weng Jianbin, Zhu Zipeng, Lin Jianjin, Li Junpeng, Xu Yanchang
Department of Gastroenterological Surgery Unit 1, The Teaching Hospital of Putian First Hospital, Fujian Medical University, Putian, Fujian, China.
Department of Gastroenterological Surgery Unit 1, Putian First Hospital, The Affiliated Hospital of Putian University, Putian, Fujian, China.
Front Oncol. 2025 Apr 16;15:1573018. doi: 10.3389/fonc.2025.1573018. eCollection 2025.
Radical gastrectomy for gastric cancer involves the en-bloc resection of the primary tumor and complete excision of the mesogastrium. However, the surgical boundaries and techniques for removing lymph nodes above the pylorus during gastric cancer surgery remain unclear. We aimed to investigate a novel, standardized approach for excising the right mesogastrium in gastric cancer patients undergoing suprapyloric lymphadenectomy, focusing on surgical techniques and outcomes.
Our surgical technique includes identifying three key elements of the mesogastrium: the encircling portion, the suspension point, and the connecting segment. Using these anatomical landmarks, we resect adipose tissue containing lymph nodes from the right mesogastrium and perform root ligation of the right gastric vessels. We then perform D2 lymphadenectomy combined with complete mesogastrium excision (D2+CME). We retrospectively analyzed clinical data from 376 patients who underwent laparoscopic radical gastrectomy with lymph node dissection for gastric cancer, comparing outcomes between laparoscopic suprapyloric lymph node dissection guided by mesogastric anatomy and traditional methods.
A total of 376 patients were included, with 166 undergoing laparoscopic radical gastrectomy with D2+CME and 210 receiving traditional laparoscopic D2 gastrectomy. No significant differences were observed between the groups in age, body mass index, comorbidities, ASA score, tumor differentiation, tumor location, or surgical approach (>0.05). The D2+CME group harvested significantly more lymph nodes than the traditional D2 group (43.84 ± 5.01 vs. 33.18 ± 2.96, <0.001). The number of positive lymph nodes was also higher in the D2+CME group (6.12 ± 0.89 vs. 2.86 ± 0.55, <0.001). The number of lymph nodes harvested from the right mesogastrium was greater in the D2+CME group (3.41 ± 0.48 vs. 1.32 ± 0.37, <0.001). Intraoperative blood loss was lower in the D2+CME group (5.67 ± 0.41 vs. 9.96 ± 0.77, <0.001), and dissection time was shorter (27.22 ± 1.50 vs. 31.31 ± 1.53, <0.001). No significant difference was found in the number of positive lymph nodes in the right mesogastrium (>0.05).
D2+CME is a feasible and effective approach for laparoscopic radical gastrectomy for gastric cancer. The mesogastric anatomical-guided method for suprapyloric lymph node dissection is safe, reliable, and improves lymph node dissection quality while reducing operative time.
胃癌根治性胃切除术包括整块切除原发肿瘤和完整切除胃系膜。然而，胃癌手术中幽门以上淋巴结清扫的手术边界和技术仍不明确。我们旨在研究一种新颖、标准化的方法，用于在接受幽门上淋巴结清扫术的胃癌患者中切除右胃系膜，重点关注手术技术和结果。
我们的手术技术包括识别胃系膜的三个关键要素：环绕部分、悬吊点和连接段。利用这些解剖标志，我们从右胃系膜切除含淋巴结的脂肪组织，并对胃右血管进行根部结扎。然后我们进行D2淋巴结清扫联合完整胃系膜切除（D2+CME）。我们回顾性分析了376例行腹腔镜胃癌根治性切除术并进行淋巴结清扫患者的临床资料，比较了在胃系膜解剖引导下的腹腔镜幽门上淋巴结清扫与传统方法的结果。
共纳入376例患者，其中166例行D2+CME的腹腔镜根治性胃切除术，210例接受传统腹腔镜D2胃切除术。两组在年龄、体重指数、合并症、ASA评分、肿瘤分化、肿瘤位置或手术方式方面均无显著差异（>0.05）。D2+CME组切除的淋巴结明显多于传统D2组（43.84±5.01对33.18±2.96，<0.001）。D2+CME组阳性淋巴结数量也更高（6.12±0.89对2.86±0.55，<0.001）。D2+CME组从右胃系膜切除的淋巴结数量更多（3.41±0.48对1.32±0.37，<0.001）。D2+CME组术中出血量更低（5.67±0.41对9.96±0.77，<0.001），清扫时间更短（27.22±1.50对31.31±1.53，<0.001）。右胃系膜阳性淋巴结数量无显著差异（>0.05）。
D2+CME是腹腔镜胃癌根治性切除术的一种可行且有效的方法。胃系膜解剖引导下的幽门上淋巴结清扫方法安全、可靠，可提高淋巴结清扫质量并缩短手术时间。
