Analysis of feasibility of selectively preserving the first branch of the right gastro-omental artery using bidirectional dissection in laparoscopic pylorus-preserving gastrectomy
10.3760/cma.j.cn441530-20230920-00098
- VernacularTitle:基于双向解剖的选择性保留胃网膜右血管第一分支在腹腔镜胃癌保留幽门手术中的可行性分析
- Author:
Zeyao YE
1
;
Pengfei YU
;
Yang CAO
;
Tengjiao CHAI
;
Binzhong ZHANG
;
Jun SIMA
;
Bing WANG
;
Zhihui JIANG
;
Pingyuan YU
;
Weixing WU
;
Yi'an DU
Author Information
1. 浙江省肿瘤医院胃外科，杭州 310022
- Keywords:
Stomach neoplasms, early;
Laparoscopic pylorus-preserving gastrectomy;
Bidirectional dissection;
Selective preservation of the first branch of the right
- From:
Chinese Journal of Gastrointestinal Surgery
2024;27(8):840-845
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To assess the safety and feasibility of selectively preserving the first branch of the right gastro-omental artery using bidirectional dissection in laparoscopic pylorus-preserving gastrectomy (LPPG).Methods:In this retrospective analysis, we studied preoperative, intraoperative, postoperative, and follow-up data of 30 patients with early gastric cancer treated in the Department of Gastric Cancer in Zhejiang Cancer Hospital (28 patients), Department of Gastrointestinal Surgery in Jiaxing Second Hospital (one patient) and Department of Gastrointestinal Surgery in Hangzhou Red Cross Hospital (one patient) who had undergone selective preservation of the first branch of the right gastro-omental artery during LPPG. The main variables studied were as follows: (1) intraoperative preservation of the first branch of the right gastro-omental artery; (2) the overall surgical situation; and (3) postoperative small bowel follow-through and endoscopy findings.Results:LPPG with selective preservation of the right gastro-omental artery vascular branch was achieved in all 30 of the study patients. The mean operation time was (244.3±29.3) minutes and the median intraoperative blood loss 50 (20–200) mL. The median tumor diameter was 1.2 (0.5–3.6) cm and an average of 32.3±11.6 lymph nodes were dissected. The overall median number of positive lymph nodes was 0 (0–6), and of No. 6 lymph nodes 5.1±1.5. Postoperative feeding resumed at an average of 5.2±0.5 days and the postoperative hospital stay averaged 8.4±3.4 days. Pathological stages were as follows: T1a (14 cases), T1b (10 cases), and T2 (6 cases). Small bowel follow-through imaging showed good results in 28 patients 5 days post-surgery, the remaining two exhibiting good results 9 days post-surgery. There were no instances of delayed gastric emptying, and only one patient (3.3%) developed intra-abdominal infection (resolved with conservative treatment).Conclusion:Selective preservation of the right gastro-omental artery during laparoscopic early gastric cancer surgery is a safe and feasible procedure for treating early mid-gastric body cancer with pyloric preservation.
