복강경 보조 위전절제술에서 Downstream Procedure의 유용성

Abstract

Purpose: There is a recent increased interest in laparoscopy-assisted total gastrectomy (LATG) as a result of the increasing incidence of finding early stage gastric cancer and upper-located gastric cancer. However, there are still some problems. The first problem is the technical difficulty of dissecting the No. 10 and No. 11 lymph nodes, and the second problem is there is no established method for reconstruction after LATG. The purpose of this study was to propose a new procedure for radical lymph node dissection in LATG. Methods: We call our procedure The Downstream Procedure" and it is as follows. After the ligation of the left gastric artery, we first performed intracorporeal esophagectomy after the clamping the esophagus with endo-vascular clamps. The cardia of the stomach was retracted caudally and we dissected the lymph nodes along the splenic artery (No. 11d) and around the splenic hilum (No. 10). Results: We performed LATG with the downstream procedure in 17 patients. There was no conversion to open gastrectomy and the mean operation time was 231 minutes and the mean number of retrieved lymph nodes was 37. The proximal and distal margins were 3.86 cm and 14.97 cm, respectively. The morbidity after the downstream procedure was 11.8% and there was no mortality. Conclusion: We used the new method "The Downstream Procedure" for LATG and we were able to get a better visual field of the area of the No. 11d and 10 lymph nodes and we could more easily perform the lymph node dissection. The downstream procedure is an easy, safe method for the lymph node dissection when performing LATG for upper early gastric cancer."