Robotic spleen‑preserving suprapancreatic and splenic hilar lymph node dissection using the preemptive retropancreatic approach in total gastrectomy for gastric cancer.
Postoperative complications
Robotic total gastrectomy
Splenic hilar lymph nodes
Suprapancreatic lymph nodes
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
17 May 2024
17 May 2024
Historique:
received:
17
05
2022
accepted:
08
05
2024
medline:
17
5
2024
pubmed:
17
5
2024
entrez:
17
5
2024
Statut:
aheadofprint
Résumé
Advanced gastric cancer that has not invaded the greater curvature is a good indication for total gastrectomy (TG) with spleen-preserving suprapancreatic and splenic hilar lymph node dissection (LND). However, the suprapancreatic and splenic hilar LND increases the area of dissection of the pancreas, and prolonged pressure drainage of the pancreas is required to maintain a clear operative view. This can lead to an increased risk of postoperative pancreatic complications. To report the efficacy of our novel preemptive retropancreatic approach (PRA) for the suprapancreatic and splenic hilar LND in robotic TG (RTG). We report our experience with nine patients with gastric cancer who underwent spleen-preserving splenic hilar LND using PRA during RTG at Hokkaido University from October 2018 to November 2021. The PRA involves initial dissection of the left side of the retropancreatic space, followed by the release of the adherence between the retroperitoneum surface and the pancreas (fusion fascia), which provides a good operative field and prevents contact with the pancreas during the suprapancreatic and splenic hilar LND in RTG. The median operating time was 488 min (254-564 min). The median intraoperative bleeding was 55 mL (0-115 mL). One patient had postoperative complications (above grade II of the Clavien-Dindo classification), but there were no postoperative pancreatic complications. The spleen-preserving suprapancreatic and splenic hilar LND using PRA could help to reduce the postoperative pancreatic complications associated with RTG.Trial registration number and date of registration The Hokkaido University Hospital institutional review board approved the data collection and analysis. The trial registration number and date of registration are No. 021-0022 and July 26, retrospectively registered.
Identifiants
pubmed: 38758469
doi: 10.1007/s13304-024-01880-w
pii: 10.1007/s13304-024-01880-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. Italian Society of Surgery (SIC).
Références
Kang BH, Xuan Y, Hur H, Ahn CW, Cho YK, Han SU (2012) Comparison of surgical outcomes between robotic and laparoscopic gastrectomy for gastric Cancer: the learning curve of robotic surgery. J Gastric Cancer 12:156–163
doi: 10.5230/jgc.2012.12.3.156
pubmed: 23094227
pmcid: 3473222
Ye SP, Shi J, Liu DN, Jiang QG, Lei X, Qiu H, Li TY (2019) Robotic-assisted versus conventional laparoscopic-assisted total gastrectomy with D2 lymphadenectomy for advanced gastric cancer: short-term outcomes at a mono-institution. BMC Surg 19:86
doi: 10.1186/s12893-019-0549-x
pubmed: 31288775
pmcid: 6617620
Ebihara Y, Kurashima Y, Murakami S, Shichinohe T, Hirano S (2021) Robotic distal gastrectomy with a novel “preemptive retropancreatic approach” during dissection of suprapancreatic lymph nodes for gastric cancer. Surg Laparosc Endosc Percutan Tech. https://doi.org/10.1097/SLE.0000000000000897
doi: 10.1097/SLE.0000000000000897
pubmed: 34545031
Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver 4). Gastric Cancer 20:1–19
doi: 10.1007/s10120-016-0622-4
Kimura K, Ebihara Y, Tanaka K, Nakanishi Y, Asano T, Noji T, Kurashima Y, Murakami S, Nakamura T, Tsuchikawa T, Okamura K, Shichinohe T, Kanno-Okada H, Hirano S (2020) Robot-assisted laparoscopic total gastrectomy for Epstein–Barrvirus-associated multiple gastric cancer: a case report. Int J Surg Case Rep 75:446–450
doi: 10.1016/j.ijscr.2020.09.147
pubmed: 33002856
pmcid: 7527680
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196
doi: 10.1097/SLA.0b013e3181b13ca2
pubmed: 19638912
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Tsujiura M, Hiki N, Ohashi M, Nunobe S, Kumagai K, Ida S, Okumura Y, Sano T, Yamaguchi T (2017) ‘Pancreas-compressionless gastrectomy’: a novel laparoscopic approach for suprapancreatic lymph node dissection. Ann Surg Oncol 24:3331–3337
doi: 10.1245/s10434-017-5974-4
pubmed: 28699131
Ida S, Hiki N, Ishizawa T, Kuriki Y, Kamiya M, Urano Y, Nakamura T, Tsuda Y, Kano Y, Kumagai K, Nunobe S, Ohashi M, Sano T (2018) Pancreatic compression during lymph node dissection in laparoscopic gastrectomy: possible cause of pancreatic leakage. J Gastric Cancer 18:134–141
doi: 10.5230/jgc.2018.18.e15
pubmed: 29984063
pmcid: 6026711
Kumamoto T, Kurahashi Y, Niwa H, Nakanishi Y, Ozawa R, Okumura K, Ishida Y, Shinohara H (2020) Laparoscopic suprapancreatic lymph node dissection using a systematic mesogastric excision concept for gastric cancer. Ann Surg Oncol 27:529–531
doi: 10.1245/s10434-019-07700-5
pubmed: 31407184