"Pancreas-Compressionless Gastrectomy": A Novel Laparoscopic Approach for Suprapancreatic Lymph Node Dissection

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Radical operations for gastric cancer require balancing lymph node dissection quality with surgical safety.
• Suprapancreatic lymphadenectomy in laparoscopic gastrectomy (LG) necessitates a safe operative field to minimize pancreas-related complications.

Purpose of the Study:

• To present a novel approach for laparoscopic gastrectomy that avoids direct pancreatic compression.
• To evaluate the surgical outcomes of this pancreas-compressionless technique compared to traditional methods.

Main Methods:

• A modified technique, termed "pancreas-compressionless gastrectomy," was introduced in March 2016.
• This method establishes the operative field by manipulating connective tissues and nerves, avoiding direct pancreatic compression.
• Surgical outcomes, including amylase concentration and postoperative complications, were compared between 51 patients in the compression group and 45 in the compressionless group.

Main Results:

• The pancreas-compressionless group showed significantly lower amylase concentrations in drainage fluid on postoperative days 1 and 3.
• Rates of severe postoperative pancreatic fistula decreased from 11.8% to 2.2%.
• Intra-abdominal infectious complications decreased significantly from 17.6% to 2.2% in the compressionless group.

Conclusions:

• The "pancreas-compressionless gastrectomy" is a safe and effective method.
• This technique helps prevent postoperative infectious complications in laparoscopic gastrectomy.
• It offers a valuable alternative for improving patient outcomes in gastric cancer surgery.