Khorobrykh Tatiana, Agadzhanov Vadim, Grachalov Anton, Ivashov Ivan, Spartak Alexey, Romanovskii Artem, Drach Yaroslav, Kharkov Daniil
Department of Faculty Surgery No. 2, Named after G.I. Lukomsky, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8-2 Trubetskaya Str., 119991 Moscow, Russia.
Department Biomedical Technical Systems of Faculty Biomedical Engineering, Federal State Autonomous Educational Institution of Higher Education Bauman Moscow State Technical University, 2-ya 5/1, Baumanskaya Str., 105005 Moscow, Russia.
J Clin Med. 2025 Sep 5;14(17):6282. doi: 10.3390/jcm14176282.
Gastric cancer remains a leading cause of cancer-related mortality, with over 50% of cases diagnosed at a locally advanced or metastatic stage. High-quality surgical resection within the embryological mesogastric layer is critical for achieving optimal oncological outcomes but is often complicated by anatomical distortion in advanced tumors. This study aimed to develop and validate a system of topographic and anatomical navigation landmarks for embryologically guided laparoscopic gastrectomy, leveraging 3D modeling to enhance precision and safety. A single-center study was conducted, analyzing 78 patients undergoing emergency laparoscopic gastrectomy for locally advanced gastric cancer. Preoperative 3D models were generated from CT data annotations to map the stomach, tumor, vascular structures, and mesogastric adipose tissue. Thirty biomodels were used to refine dissection techniques. Surgical procedures adhered to embryological principles, with lymphadenectomy guided by predefined landmarks. Histopathological validation assessed resection margins and tumor infiltration in resected specimens. Statistical analysis compared outcomes between patients with and without 3D planning. The 3D models demonstrated 100% concordance with intraoperative vascular anatomy. Radiologically dense adipose tissue, resected as potentially tumor-infiltrated, showed histopathological invasion in 74% of cases. R0 resection was achieved in 74.4% of patients. Operative time decreased from 300 to 250 min after technical optimization, with a 7.7% conversion rate (primarily due to vascular injury or tumor fixation). Postoperative mortality was 5.1%, attributed to comorbidities. Patients with 3D planning had significantly higher lymph node yields ( < 0.00001) and R0 rates ( = 0.045). The integration of embryologically based topographic landmarks and 3D navigation improves the safety and standardization of laparoscopic gastrectomy for locally advanced gastric cancer. This approach enhances oncological radicality, reduces operative time, and mitigates risks in anatomically distorted fields. Further validation in larger cohorts is warranted.
胃癌仍然是癌症相关死亡的主要原因，超过50%的病例在局部晚期或转移阶段被诊断出来。在胚胎学胃系膜层内进行高质量的手术切除对于实现最佳肿瘤学结果至关重要，但在晚期肿瘤中常因解剖结构变形而变得复杂。本研究旨在开发并验证一种用于胚胎学引导的腹腔镜胃切除术的地形和解剖导航标志系统，利用三维建模提高精度和安全性。进行了一项单中心研究，分析了78例因局部晚期胃癌接受急诊腹腔镜胃切除术的患者。术前从CT数据注释中生成三维模型，以绘制胃、肿瘤、血管结构和胃系膜脂肪组织。使用30个生物模型来完善解剖技术。手术程序遵循胚胎学原则，淋巴结清扫由预先定义的标志引导。组织病理学验证评估切除标本的切缘和肿瘤浸润情况。统计分析比较了有三维规划和没有三维规划的患者的结果。三维模型显示与术中血管解剖结构100%一致。作为潜在肿瘤浸润切除的放射学致密脂肪组织，74%的病例显示有组织病理学浸润。74.4%的患者实现了R0切除。技术优化后手术时间从300分钟降至250分钟，转化率为7.7%（主要由于血管损伤或肿瘤固定）。术后死亡率为5.1%，归因于合并症。有三维规划的患者淋巴结收获率显著更高（<0.00001），R0切除率也更高（=0.045）。基于胚胎学的地形标志和三维导航的整合提高了局部晚期胃癌腹腔镜胃切除术的安全性和标准化。这种方法增强了肿瘤根治性，减少了手术时间，并降低了解剖结构变形区域的风险。需要在更大的队列中进行进一步验证。
