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Journal of Gastrointestinal Surgery

, Volume 23, Issue 5, pp 895–903 | Cite as

Clockwise, Modularized Lymphadenectomy in Laparoscopic Gastric Cancer Surgery: a New Laparoscopic Surgery Model

  • Wei-Han Zhang
  • Kun Yang
  • Xin-Zu Chen
  • Ying Zhao
  • Kai Liu
  • Wei-Wei Wu
  • Zhi-Xin Chen
  • Zong-Guang Zhou
  • Jian-Kun HuEmail author
Original Article
  • 105 Downloads

Abstract

Background

The aim of the study is to present the clockwise, modularized lymphadenectomy model of laparoscopic gastrectomy for gastric cancer patients, which is based on our clinical practice experience in laparoscopic gastric cancer surgery.

Methods

From Jan 2015 to July 2017, 116 patients who underwent laparoscopic gastrectomy were retrospectively collected and analyzed. According to the different resection models, patients were divided into two groups: traditional laparoscopic lymphadenectomy group (63 patients) and clockwise, modularized lymphadenectomy group (53 patients). Operation-related parameters were compared between the two groups.

Results

The clockwise, modularized lymphadenectomy group had less dissection time (119.8 ± 19.1 min vs. 135.3 ± 23.8 min, p < 0.001) and less intraoperative blood loss (81.7 ± 42.9 ml vs. 91.4 ± 28.7 ml, p = 0.016) compared with the traditional laparoscopic lymphadenectomy group. Meanwhile, the clockwise, modularized lymphadenectomy group had more numbers of examined lymph nodes (40.5 ± 14.3 vs. 33.9 ± 11.0, p = 0.007) than the traditional laparoscopic lymphadenectomy group. Besides, there was no statistically significant difference in the postoperative complication rates between the two groups. The clockwise, modularized lymphadenectomy group had shorter postoperative hospital stay than the traditional laparoscopic lymphadenectomy group (8.7 ± 3.2 days vs. 10.4 ± 3.9 days, respectively, p < 0.001).

Conclusions

Through the adoption of the fixed sequence of lymphadenectomy, requirements and standard of lymphadenectomy of each lymph node station, and specific surgical skills for intraoperative exposure by the clockwise and modularized lymphadenectomy model, we can optimize and facilitate the laparoscopic gastric cancer surgery.

Keywords

Gastric cancer Lymphadenectomy Laparoscopy Surgery 

Abbreviations

TLL

Traditional laparoscopic lymphadenectomy

CML

Clockwise, modularized lymphadenectomy

BMI

Body mass index

LEGV

Left gastroepiploic vein

ISV

Inferior spleen vein

REGV

Right gastroepiploic vein

ASPDV

Anterior superior pancreaticoduodenal vein

ARCV

Accessory right colic vein

RGA CHA

Common hepatic artery

LGA

Left gastric artery

LGV

Left gastric vein

SV

Splenic vein

SA

Splenic artery

Notes

Acknowledgments

The authors thank the substantial work of the Volunteer Team of Gastric Cancer Surgery (VOLTGA) based on the Multidisciplinary Team (MDT) of Gastrointestinal Tumors, West China Hospital, Sichuan University, China.

Funding Sources

1) The National Natural Science Foundation of China (No. 81372344).

2) Sichuan Province Youth Science & Technology Innovative Research Team, No. 2015TD0009.

3) 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University, No. ZY2017304.

4) Fund for Fostering Academic and Technical Leaders of Sichuan Province, No. [2016] 183-19.

Author’s Contributions

Wei-Han Zhang, Kun Yang, and Jian-Kun Hu designed the study;

Wei-Han Zhang, Kun Yang, Kai Liu, and Wei-Wei Wu collected the clinical information;

Wei-Han Zhang, Kun Yang, Xin-Zu Chen, Zong-Guang Zhou, and Jian-Kun Hu analyzed and interpreted the data;

Wei-Han Zhang, Xin-Zu Chen, and Ying-Zhao conducted the statistical analysis;

Wei-Han Zhang, Wei-Wei Wu, and Jian-Kun Hu edited the surgical video.

Jian-Kun Hu and Zong-Guang Zhou supervised this study;

All authors contributed to the writing of the manuscript and final approval.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Supplementary material

11605_2018_4009_MOESM1_ESM.wmv (243.3 mb)
ESM 1 (WMV 249113 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Wei-Han Zhang
    • 1
  • Kun Yang
    • 1
  • Xin-Zu Chen
    • 1
  • Ying Zhao
    • 1
  • Kai Liu
    • 1
  • Wei-Wei Wu
    • 2
  • Zhi-Xin Chen
    • 1
  • Zong-Guang Zhou
    • 3
  • Jian-Kun Hu
    • 1
    Email author
  1. 1.Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China HospitalSichuan University, and Collaborative Innovation Center for BiotherapyChengduChina
  2. 2.Department of Anesthesiology, West China HospitalSichuan UniversityChengduChina
  3. 3.Department of Gastrointestinal Surgery and Laboratory of Digestive Surgery, State Key Laboratory of Biotherapy, West China HospitalSichuan University, and Collaborative Innovation Center for BiotherapyChengduChina

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