Laparoscopic Suprapancreatic and Splenic Hilar Lymph Node Dissection via a Supradorsal Mesogastric Approach for Advanced Gastric Cancer

Introduction:

For advanced gastric cancer, pancreatic manipulation is often required during laparoscopic suprapancreatic lymph node dissection and may increase the risk of postoperative pancreatic fistula.^1,2 Moreover, laparoscopic splenic hilar lymph node dissection remains technically demanding. ³ This video demonstrates a novel supradorsal mesogastric approach from a right upper abdominal perspective for laparoscopic suprapancreatic and splenic hilar lymph node dissection.

Materials and Methods:

A 70-year-old man presented with abdominal pain and dysphagia for 2 months. Endoscopy and biopsy revealed an adenocarcinoma at the gastroesophageal junction. Computed tomography showed irregular enhancing wall thickening at the gastroesophageal junction and adjacent gastric lesser curvature (cT3N1M0). The patient underwent laparoscopic total gastrectomy with D2 lymphadenectomy. ⁴ Five trocars (5, 5, 10, 10, 12 mm) were placed. Intraoperatively, the tumor was found to be more extensive than preoperatively anticipated, and spleen-preserving splenic hilar lymph node dissection was therefore additionally performed. Following mobilization of the greater omentum, duodenum, and esophagus, the operating table was adjusted to a 30° reverse Trendelenburg position with 15° right lateral tilt. The camera was inserted into the upper-right trocar. Then, suprapancreatic and splenic hilar lymph node dissection was performed via a supradorsal mesogastric approach. Next, the patient was repositioned supine, and a 5-cm longitudinal incision was made for specimen extraction. Finally, a side-overlap esophagojejunostomy and Roux-en-Y jejunojejunostomy were performed. ⁵

Results:

The operative time was 180 min. The blood loss was 50 mL. Postoperative course was uneventful, and the patient was discharged 7 days after surgery. Postoperative pathology confirmed a gastric adenocarcinoma (pT3N1M0). All margins were clear.

Conclusions:

For selected patients with gastric cancer, the supradorsal mesogastric approach from a right upper abdominal perspective is feasible for laparoscopic suprapancreatic and splenic hilar lymph node dissection.

This study was approved by the Ethics Committee of The General Hospital of Western Theater Command.

The data generated and analyzed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author upon reasonable request.

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

This work was supported by the Healthcare Backbone Talent Program (41C41C223).

The authors declare that they have no conflicts of interest.

Runtime of video: 7 min 13 sec.