Laparoscopic perigastric mesogastrium excision technique for radical total gastrectomy

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Complete mesogastrium excision (CME) and lymph node (LN) dissection (nos. 10 and 11) are technically demanding in laparoscopic radical total gastrectomy (LRTG).
• The laparoscopic perigastric mesogastrium excision technique (LPMET) and the "enjoyable space" concept were developed to address these challenges.

Purpose of the Study:

• To introduce the laparoscopic perigastric mesogastrium excision technique (LPMET) and the "enjoyable space" for laparoscopic radical total gastrectomy.
• To characterize the perigastric space and surgical plane for improved dissection.

Main Methods:

• Retrospective analysis of 79 upper gastric cancer cases undergoing laparoscopic D2 gastrectomy plus CME from July 2016 to June 2017.
• Evaluation of patient characteristics, operative outcomes, and postoperative results.

Main Results:

• Successful completion of laparoscopic D2 gastrectomy plus CME in all 79 patients.
• Mean surgical time: 232.5 min; mean blood loss: 67.6 ml; mean LNs retrieved: 28.1.
• Postoperative morbidity rate: 17.7%; median follow-up: 12 months with one case of liver metastasis and no deaths or recurrence.

Conclusions:

• The laparoscopic perigastric mesogastrium excision technique (LPMET) and "enjoyable space" offer a novel, minimally invasive method for CME.
• This approach facilitates the dissection of lymph nodes no. 10 and no. 11 during laparoscopic radical total gastrectomy.