SUTUDY OF LAPAROSCOPY-ASSISTED DISTAL GASTRECTOMY WITH D1+βLYMPH NODE DISSECTION FOR SUBMUCOSAL GASTRIC CANCER LOCATED IN MIDDLE AND LOWER THIRD OF STOMACH

—Indication for laparoscopy assisted distal gastrectomy with D1+βlymph node dissection and operative method—

Abstract

We report a study of laparoscopy-assisted distal gastrectomy with D1+βlymph node dissection (LADG with D1+β) for submucosal gastric cancer located in the middle and lower third of the stomach. Indications for LADG with D1+β were studied from lymph node metastases of cases of open distal gastrectomy. A significant difference was found in the lymph node metastasis rate according to the enlargement of tumor diameter. Only one Pathological N2 case was recognized in submucosal gastric cancer less than 40 mm with a differentiated type and less than 20 mm with an undifferentiated type. However, this case has not been recurrent. therefore, the indications for LADG with D1+βare 1. submucosal gastric cancer with a differentiated type of more than 15 mm and less than 40 mm, and 2, submucosal gastric cancer with an undifferentiated type of less than 20 mm. In the operating method, five trockers are inserted, and a laparoscope is put below the navel. All lymph node dissections are finished laparoscopically. A longitudinal dissection with 5 cm is put under the xiphisternum and distal gastrectomy is performed. Reconstruction is done by the Billroth I method. In laparoscopy-assisted distal gastrectomy, the mean dissected lymph node number is the same, the mean operating time is longer and the mean blood loss is less than in open distal gastrectomy.