[Laparoscopic Proximal Gastrectomy with Supra-Pancreatic Dissection First Approach]

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Context:

• Laparoscopic proximal gastrectomy (LPG) for upper gastric cancer requires effective exclusion of the stomach from the supra-pancreatic area for optimal surgical visualization.
• Achieving a clear surgical view is crucial for successful esophago-gastric anastomosis.

Purpose:

• To evaluate a modified LPG technique involving initial supra-pancreatic dissection to improve surgical view and efficiency.
• To compare the surgical outcomes of this new approach (S group) against a previous method (G group).

Summary:

• The modified technique involves dissecting the lesser curvature first, followed by supra-pancreatic dissection and gastro-splenic ligament division from the cranial side.
• This approach was performed in 20 patients with upper gastric cancer.
• The median operative time was significantly shorter in the S group (226 min) compared to the G group (249 min, p=0.02), with similar other outcomes.

Impact:

• The supra-pancreatic dissection first approach in LPG is safe and feasible for treating upper gastric cancer.
• This technique offers a potential advantage by reducing operative time, contributing to improved patient outcomes in minimally invasive gastrointestinal surgery.