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09 May 2020 : Clinical Research  

The Retropancreatic Fusion Fascia Oriented Splenic Hilar Lymphadenectomy Versus Laparoscopic Approach In D2 Total Gastrectomy

Mengyin Peng1ABCDEF, Jian Liu1ABC, XiaoBo Yang1ABCDE, ShiChen Liu1ABCD, Miao Wu1ABCDEFG*

DOI: 10.12659/MSM.919003

Med Sci Monit 2020; 26:e919003

Abstract

BACKGROUND: The retropancreatic fusion fascia is recognized as the anatomical landmark during retropancreatic mobilization. However, its role in D2 total gastrectomy for proximal advanced gastric cancer (PAGC) remains unexplored. This study aimed to develop the retropancreatic fusion fascia-oriented ex vivo approach for splenic hilar lymphadenectomy (RP-SL) to avoid difficulty in using the total laparoscopic approach (TL-SL).

MATERIAL AND METHODS: The data for patients with PAGC who underwent D2 total gastrectomy were retrieved from our clinical database and electronic medical records (December 2016 to December 2018), with a 1:1 match ratio for balance of the 2 groups.

RESULTS: In sum, 84 matched patients were included in the study. There were 2360 retrieved lymph nodes (LNs), with an average of 28.10. Sixteen patients were confirmed with positive splenic hilar lymphadenectomy, and the mean harvested lymph nodes (LNs) were significantly increased in the RP-SL group compared to the TL-SL group (3.07 vs. 2.29, P<0.001), decreased operative time (193.21 min vs. 247.74 min, P<0.001), and less blood loss (96.90 mL vs. 185.24 mL, P=0.001) in the RP-SL group. Postoperative hospital stay (6.55 days vs. 7.26 days), rate of morbidity (9.50% vs. 11.91%), and overall costs (¥65255.64 vs. ¥64419.91) were comparable between the groups (P>0.05). 

CONCLUSIONS: The landmark at the conjunction between the superior mesenteric vessels and the inferior pancreatic margin made it feasible to identify the retropancreatic areolar. The RP-SL approach was safe and efficient for splenic hilar lymphadenectomy.

Keywords: Fascia, Hand-Assisted Laparoscopy, Lymph Node Excision, Anatomic Landmarks, Gastrectomy, Length of Stay, Lymph Nodes, operative time, Spleen

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750