Objective:To introduce the clinical application of "page-turning" superior pancreatic lymph node dissection in laparoscopic D2 radical gastrectomy for gastric cancer.Methods:Patients who were confirmed to have adenocarcinoma by preoperative gastroscopy and pathological biopsy, with tumor staging evaluated by imaging as cT1~4aN0~3M0, without neoadjuvant therapy, and without absolute surgical contraindications, underwent laparoscopic radical gastrectomy for gastric cancer with "page-turning" superior pancreatic lymph node dissection. The "page-turning" superior pancreatic lymph node dissection was performed in four steps: (1) Expose the posterior gastric mesentery and dissect No.11p lymph nodes; (2) Expose the left gastric mesentery and dissect No.7, No.8a and No.9 lymph nodes; (3) Expose the right gastric mesentery and dissect No.5 lymph nodes; (4) Expose the left edge of the portal vein and dissect No.12a lymph nodes.Results:From April 2018 to October 2024, 112 patients with gastric cancer underwent laparoscopic D2 radical gastrectomy with "page-turning" superior pancreatic lymph node dissection, including 21 cases in the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 78 cases in the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, and 13 cases in the Department of Gastrointestinal Surgery, Jilin Provincial People's Hospital. The TNM staging of all patients was as follows: 31 cases in stage Ⅰ, 24 cases in stage Ⅱ, and 57 cases in stage Ⅲ; 62 cases of differentiated adenocarcinoma and 50 cases of undifferentiated adenocarcinoma; the median length of tumors was 3.8 cm. All patients successfully completed the operation without conversion to open surgery, no intraoperative massive hemorrhage or postoperative death. The median total number of lymph nodes dissected in all patients was 32, and the median number of positive lymph nodes was 4.5. The overall postoperative complication rate was 5.4% (6/112), all of which were Clavien-Dindo grade Ⅱ, including pulmonary infection, pleural effusion, and incisional infection, all cured by symptomatic treatment. The median follow-up was 41.8 (2-78) months, with 7 cases lost to follow-up. During the follow-up period, 27 cases (25.7%) had tumor recurrence and 16 cases (15.2%) died.Conclusions:The "page-turning" superior pancreatic lymph node dissection technique is safe and feasible in laparoscopic radical gastrectomy for gastric cancer.

Objective:To introduce the clinical application of "page-turning" superior pancreatic lymph node dissection in laparoscopic D2 radical gastrectomy for gastric cancer.Methods:Patients who were confirmed to have adenocarcinoma by preoperative gastroscopy and pathological biopsy, with tumor staging evaluated by imaging as cT1~4aN0~3M0, without neoadjuvant therapy, and without absolute surgical contraindications, underwent laparoscopic radical gastrectomy for gastric cancer with "page-turning" superior pancreatic lymph node dissection. The "page-turning" superior pancreatic lymph node dissection was performed in four steps: (1) Expose the posterior gastric mesentery and dissect No.11p lymph nodes; (2) Expose the left gastric mesentery and dissect No.7, No.8a and No.9 lymph nodes; (3) Expose the right gastric mesentery and dissect No.5 lymph nodes; (4) Expose the left edge of the portal vein and dissect No.12a lymph nodes.Results:From April 2018 to October 2024, 112 patients with gastric cancer underwent laparoscopic D2 radical gastrectomy with "page-turning" superior pancreatic lymph node dissection, including 21 cases in the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 78 cases in the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, and 13 cases in the Department of Gastrointestinal Surgery, Jilin Provincial People's Hospital. The TNM staging of all patients was as follows: 31 cases in stage Ⅰ, 24 cases in stage Ⅱ, and 57 cases in stage Ⅲ; 62 cases of differentiated adenocarcinoma and 50 cases of undifferentiated adenocarcinoma; the median length of tumors was 3.8 cm. All patients successfully completed the operation without conversion to open surgery, no intraoperative massive hemorrhage or postoperative death. The median total number of lymph nodes dissected in all patients was 32, and the median number of positive lymph nodes was 4.5. The overall postoperative complication rate was 5.4% (6/112), all of which were Clavien-Dindo grade Ⅱ, including pulmonary infection, pleural effusion, and incisional infection, all cured by symptomatic treatment. The median follow-up was 41.8 (2-78) months, with 7 cases lost to follow-up. During the follow-up period, 27 cases (25.7%) had tumor recurrence and 16 cases (15.2%) died.Conclusions:The "page-turning" superior pancreatic lymph node dissection technique is safe and feasible in laparoscopic radical gastrectomy for gastric cancer.

Objective To explore the feasibility of using the consensus of European Working Group on Sarcopenia in Older People(EWGSOP) to diagnose sarcopenia among community-dwelling women aged from seventy to seventy-nine in Shanghai.Methods Twenty-two healthy community-dwelling women were recruited as the subject group(group S),and another ten young girls were randomly selected as the control group(group C).The anthropometry,bioelectrical impedance analysis(BIA)and dual energy X-ray absorptionmetry(DEXA)were used to evaluate the circumferences of upper and lower limbs,and the dimension of muscle mass,according to relative appendicular skeletal mass(RASM)and skeletal muscle index(SMI).The grip dynamometer and isokinetic dynamometer were used to measure the muscle strength of upper and lower limbs.The ten meters gait speed,functional reach test,timed up and go test,Berg balance scale and short physical performance battery were all applied to assess the physical performance.The criteria of EWGSOP consensus were applied to diagnose the situation of sarcopenia.Results Firstly,the average biceps circumference and fat mass of upper limbs in group S were significantly higher than group C (P＜0.01),while no significant differences were observed in the muscle mass(P＞0.05).Secondly,RASM values gained from BIA and DEXA in S group were significantly higher than C group(P＜0.05),while the SMI values of the former were significantly lower than the latter(P＜ 0.01).Thirdly,absolute grip strength,relative grip strength and other bio-mechanical indexes of lower limbs in the s group were significantly lower than the C group(P＜0.01);the relative grip strength showed significant correlation with most bio-mechanical indexes of lower limbs.Fourthly,the physical performance in group S declined significantly compared with that of the c group(P＜O.05),and no significant correlation was found between muscle strength and physical performance of upper limbs except the absolute grip strength and gait speed.The prevalence was 0％ according to the RASM index,while the prevalence was 63.6％ and 45.4％ according to the BIA and DEXA respectively.Conclusion The assessing pattern from EWGSOP consensus could not be simply copied to applying on Chinese old people due to serious difference between RASM and SMI.The combination of SMI+relative grip strength+ TUG/SPPB/Berg may be better than the classical mode of RASM+absolute grip strength+gait speed in diagnosing sarcopenia.