{"title":"Mesenteric-guided approach to pyloric lymphadenectomy in laparoscopic radical gastrectomy.","authors":"Guo-Feng Pan, Wei-Hong Zhang, Zhi-Ming Cai, Jian Chen, Ji-Huang Wu, Jian-Bin Weng, Zi-Peng Zhu, Zhi-Xing Guo, Jian-Jin Lin, Zhi-Xiong Li, Yan-Chang Xu","doi":"10.4240/wjgs.v17.i9.110064","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Lymphadenectomy of the infrapyloric region remains technically demanding in laparoscopic radical gastrectomy. Traditional vessel-guided approaches often result in incomplete dissection and higher complication rates, especially at station No. 6.</p><p><strong>Aim: </strong>To propose a mesentery-based strategy for infrapyloric lymphadenectomy and evaluate its safety, feasibility, and efficacy.</p><p><strong>Methods: </strong>By identifying key anatomical landmarks and defining the inferior mesenteric boundary of the pyloric region (right gastro-omental mesentery), this approach enables full exposure and <i>en bloc</i> resection of anterior and posterior mesenteric planes, with proximal ligation at the root of feeding vessels. A retrospective cohort study was conducted on 330 gastric cancer patients who underwent D2 lymphadenectomy (D2) from January 2020 to December 2021. Outcomes were compared between 165 patients treated with D2 plus complete mesogastric excision (D2 + CME) and 165 matched controls receiving conventional D2.</p><p><strong>Results: </strong>The D2 + CME group demonstrated significantly improved surgical outcomes, including shorter total operative time (279.19 ± 45.50 minutes <i>vs</i> 301.25 ± 52.30 minutes, <i>P</i> < 0.001), reduced infrapyloric dissection time (22.24 ± 3.80 minutes <i>vs</i> 27.58 ± 4.20 minutes, <i>P</i> < 0.001), and lower blood loss (4.71 ± 1.12 mL <i>vs</i> 24.83 ± 6.35 mL, <i>P</i> < 0.001). More lymph nodes were retrieved overall (43.80 ± 10.05 <i>vs</i> 37.25 ± 8.80, <i>P</i> < 0.001), particularly at station No. 6 (5.26 ± 0.87 <i>vs</i> 4.14 ± 0.41, <i>P</i> < 0.001). Postoperative recovery indicators and hospital stay were comparable between groups, while the complication rate was significantly lower in the D2 + CME group (20% <i>vs</i> 30.3%, <i>P</i> = 0.042).</p><p><strong>Conclusion: </strong>The mesentery-based approach enables safe pyloric lymphadenectomy. Systematic mesogastric excision improves operative efficiency and lymph node yield, especially at station No. 6, offering potential oncological benefits in gastric cancer surgery.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"110064"},"PeriodicalIF":1.7000,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476657/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Gastrointestinal Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4240/wjgs.v17.i9.110064","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Lymphadenectomy of the infrapyloric region remains technically demanding in laparoscopic radical gastrectomy. Traditional vessel-guided approaches often result in incomplete dissection and higher complication rates, especially at station No. 6.
Aim: To propose a mesentery-based strategy for infrapyloric lymphadenectomy and evaluate its safety, feasibility, and efficacy.
Methods: By identifying key anatomical landmarks and defining the inferior mesenteric boundary of the pyloric region (right gastro-omental mesentery), this approach enables full exposure and en bloc resection of anterior and posterior mesenteric planes, with proximal ligation at the root of feeding vessels. A retrospective cohort study was conducted on 330 gastric cancer patients who underwent D2 lymphadenectomy (D2) from January 2020 to December 2021. Outcomes were compared between 165 patients treated with D2 plus complete mesogastric excision (D2 + CME) and 165 matched controls receiving conventional D2.
Results: The D2 + CME group demonstrated significantly improved surgical outcomes, including shorter total operative time (279.19 ± 45.50 minutes vs 301.25 ± 52.30 minutes, P < 0.001), reduced infrapyloric dissection time (22.24 ± 3.80 minutes vs 27.58 ± 4.20 minutes, P < 0.001), and lower blood loss (4.71 ± 1.12 mL vs 24.83 ± 6.35 mL, P < 0.001). More lymph nodes were retrieved overall (43.80 ± 10.05 vs 37.25 ± 8.80, P < 0.001), particularly at station No. 6 (5.26 ± 0.87 vs 4.14 ± 0.41, P < 0.001). Postoperative recovery indicators and hospital stay were comparable between groups, while the complication rate was significantly lower in the D2 + CME group (20% vs 30.3%, P = 0.042).
Conclusion: The mesentery-based approach enables safe pyloric lymphadenectomy. Systematic mesogastric excision improves operative efficiency and lymph node yield, especially at station No. 6, offering potential oncological benefits in gastric cancer surgery.
背景：在腹腔镜胃根治术中，幽门下淋巴结切除术的技术要求仍然很高。传统的血管引导入路往往导致解剖不完全和更高的并发症发生率，特别是在6号手术位。目的：提出一种基于肠系膜的幽门下淋巴结切除术策略，并评价其安全性、可行性和有效性。方法：通过识别关键解剖标志和确定幽门区域的肠系膜下边界（右胃-网膜肠系膜），该入路可以实现肠系膜前后平面的完全暴露和整体切除，并在喂食血管根部近端结扎。对2020年1月至2021年12月接受D2淋巴结切除术（D2）的330例胃癌患者进行了回顾性队列研究。165例D2 +完全胃系膜切除术（D2 + CME）患者与165例常规D2对照患者的结果进行了比较。结果：D2 + CME组手术效果明显改善，总手术时间缩短（279.19±45.50 min vs 301.25±52.30 min, P < 0.001），幽门下剥离时间缩短（22.24±3.80 min vs 27.58±4.20 min, P < 0.001），出血量减少（4.71±1.12 mL vs 24.83±6.35 mL, P < 0.001）。总体淋巴结清扫率较高（43.80±10.05 vs 37.25±8.80,P < 0.001），特别是6号工位淋巴结清扫率较高（5.26±0.87 vs 4.14±0.41,P < 0.001）。两组术后恢复指标和住院时间比较，D2 + CME组并发症发生率明显低于对照组（20% vs 30.3%, P = 0.042）。结论：基于肠系膜的入路是安全的幽门淋巴结切除术。系统性胃系膜切除术提高了手术效率和淋巴结产出率，特别是在6号手术位，为胃癌手术提供了潜在的肿瘤学益处。
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