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. 2024 Feb 22;24(1):69.
doi: 10.1186/s12893-024-02349-8.

Preoperative evaluation to determine the difficulty of No. 6 lymphadenectomy in laparoscopic gastrectomy

Chie Takasu  1 , Masaaki Nishi  2 , Kozo Yoshikawa  2 , Takuya Tokunaga  2 , Hideya Kashihara  2 , Yuma Wada  2 , Toshiaki Yoshimoto  2 , Mitsuo Shimada  2
Affiliations

Preoperative evaluation to determine the difficulty of No. 6 lymphadenectomy in laparoscopic gastrectomy

Chie Takasu et al. BMC Surg. .

Abstract

Background: Laparoscopic gastrectomy (LG) requires a long learning curve because of the complicated surgical procedures. Infrapyloric (No. 6) lymph node dissection (LND) is one of the difficult procedures in LG, especially for trainees. This study investigated the impact of the prediction of the difficulty of No. 6 LND.

Methods: We retrospectively reviewed the preoperative computed tomography (CT) images and individual operative video records of 57 patients who underwent LG with No. 6 LND to define and predict the No. 6 LND difficulty. To evaluate whether prediction of the difficulty of No. 6 LND could improve surgical outcomes, 48 patients who underwent laparoscopic distal gastrectomy were assessed (30 patients without prediction by a qualified surgeon and 18 patients with prediction by a trainee).

Results: The anatomical characteristic that LND required > 2 cm of dissection along the right gastroepiploic vein was defined as difficulty of No. 6 LND. Of the 57 LG patients, difficulty was identified intraoperatively in 21 patients (36.8%). Among the several evaluated anatomical parameters, the length between the right gastroepiploic vein and the right gastroepiploic artery in the maximum intensity projection in contrast-enhanced CT images was significantly correlated with the intraoperative difficulty of No. 6 LND (p < 0.0001). Surgical outcomes, namely intraoperative minor bleeding, postoperative pancreatic fistula, and drain amylase concentration were not significantly different between LG performed by a trainee with prediction compared with that by a specialist without prediction.

Conclusions: Preoperative evaluation of the difficulty of No. 6 LND is useful for trainees, to improve surgical outcomes.

Keywords: Gastric cancer; Laparoscopic gastrectomy; No. 6 LND; Pancreatic fistula; Prediction; Trainee.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Intraoperative images of a difficult case of No. 6 lymph node dissection. Two representative images of a difficult case are shown (a, b). The top of the pancreas was far from the root of the RGEV, and longer LND was required than in an average case. We defined this characteristic, i.e., dissection along the RGEV required a distance of > 2 cm, as difficulty of No. 6 LND. RGEV right gastroepiploic vein, ASPDV anterior superior pancreaticoduodenal vein, ARCV accessory right colic vein, LND lymph node dissection
Fig. 2
Fig. 2
Representative MIP images of the anatomical parameters. (a) Measurement of the slope distance between the root of the RGEV and the RGEA (b) Measurement of the horizontal distance between the points of the upper edge of the pancreas and the root of the RGEV (c) Measurement of the slope distance between the right edge of the pancreas where the RGEV passes through and the root of the RGEV. MIP maximum intensity projection, RGEV right gastroepiploic vein, RGEA right gastroepiploic artery
Fig. 3
Fig. 3
Representative intraoperative images of minor bleeding. (a) Hemostasis using an absorbable hemostatic agent. (b) Hemostasis using a coagulation system
See this image and copyright information in PMC

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