Ann Surg Oncol (2017) 24:2727 DOI 10.1245/s10434-017-5877-4 O R I G IN AL ARTI CL E – GA STROIN TESTINA L O N C OLO G Y Radical Lymph Node Dissection Along the Proximal Splenic Artery During Laparoscopic Gastrectomy for Gastric Cancer Using the Left Lateral Approach Shingo Kanaji, MD, PhD, Satoshi Suzuki, MD, PhD, Masashi Yamamoto, MD, PhD, Yoshiko Matsuda, MD, PhD, Kimihiro Yamashita, MD, PhD, Takeru Matsuda, MD, PhD, Taro Oshikiri, MD, PhD, Tetsu Nakamura, MD, PhD, Yasuo Sumi, MD, PhD, and Yoshihiro Kakeji, MD, PhD Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan ABSTRACT the proximal SA and left side of the CA were removed in Background. Recent technical improvements allow safe all patients. laparoscopic lymph node dissection (LND) in gastric can- Conclusion. This procedure enables early identiﬁcation of 1,2 cer. In suprapancreatic LND, careful LND around the the dorsal layer and deep LND around the left side of the celiac artery (CA) is essential. From a patient’s right side, CA, keeping this layer. The left lateral approach is useful deep LND is performed around the right side of the CA for radical LND along the proximal SA. after dissecting around the common hepatic artery (CHA). For LND around the left side of the CA on the same DISCLOSURE Shingo Kanaji, Satoshi Suzuki, Masashi Yama- operative axis as the right side, we developed a new pro- moto, Yoshiko Matsuda, Kimihiro Yamashita, Takeru Matsuda, Taro cedure for LND along the proximal splenic artery (SA), Oshikiri, Tetsu Nakamura, Yasuo Sumi, and Yoshihiro Kakeji have performed from the patient’s left side. no commercial associations that may create a conﬂict of interest in Methods. After LND around the CHA and right side of the connection with any of the products mentioned in this article. CA from the patient’s right side, the surgeon then moves to the patient’s left side. The anterior pancreatic fascia is cut at REFERENCES the middle point of the SA to discern the dorsal layer of the 1. Kanaya S, Haruta S, Kawamura Y, Yoshimura F, Inaba K, Hiramatsu LN along the SA, such as the splenic vein. LND is per- Y, et al. Video: laparoscopy distinctive technique for suprapancre- formed by preserving the posterior pancreatic fascia around atic lymph node dissection: medial approach for laparoscopic gastric the SA in a left-to-right direction. Finally, the LNs around cancer surgery. Surg Endosc. 2011;25:3928–3929 the left side of the CA are deeply dissected. 2. Okabe H, Obama K, Kan T, Tanaka E, Itami A, Sakai Y. Medial approach for laparoscopic total gastrectomy with splenic lymph Results. We performed this procedure on ten patients node dissection. J Am Coll Surg. 2010;211:e1–6 between April 2016 and January 2017; no operative com- 3. Dindo D, Demartines N, Clavien PA. Classiﬁcation of surgical plications were reported in grade II or higher cancer complications: a new proposal with evaluation in a cohort of 6336 patients. After exposing the dorsal landmark, LNs around patients and results of a survey. Ann Surg. 2004;240:205–213 Electronic supplementary material The online version of this article (doi:10.1245/s10434-017-5877-4) contains supplementary material, which is available to authorized users. Society of Surgical Oncology 2017 First Received: 2 February 2017; Published Online: 15 May 2017 S. Kanaji, MD, PhD e-mail: email@example.com
Annals of Surgical Oncology – Springer Journals
Published: May 15, 2017
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