Significance and Surgical Skill for Lymphadenectomy Around Common Hepatic Artery in Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Jiankun , CHEN Zhixin , ZHANG Bo , CHEN Jiaping

Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Stomach neoplasm; Surgery; Lymphadenectomy

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To investigate the significance and surgical skill for lymphadenectomy around common hepatic artery in gastric cancer.
Methods 　Two hundred and fifty-seven cases with undergoing lymphadenectomy around common hepatic artery in gastric cancer between January 2001 and December 2006 were retrospectively reviewed. Experiences and understanding of dealing with this procedure in curative gastrectomy for gastric cancer were concluded.
Results 　The number of dissected No.8 lymph node was 2.2±1.7, and the positive rate of No.8 lymph node was 30.35%. There were no lymphadenectomy related complications, such as anastomotic leakage, lymphatic fistula and postoperative hemorrhage in this series. Dissection around common hepatic artery lymph nodes along artery intrathecal space, division and ligation of left gastric vein at its root, and sufficient exposure of anatomic structures were important to dissection lymph nodes around the common hepatic artery. The exposure of anatomic structures included liberation of common hepatic artery by traction with the band, and the exposure of posterior side of pancreas by Kocher incision.
Conclusion 　Being familiar with the anatomy around common hepatic artery, careful dissection, and attention to the surgical skill of lymphadenectomy are very important to improve the effectiveness of lymphadenectomy around common hepatic artery in gastric cancer.

Citation： HU Jiankun,CHEN Zhixin,ZHANG Bo,CHEN Jiaping. Significance and Surgical Skill for Lymphadenectomy Around Common Hepatic Artery in Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2007, 14(5): 560-563. doi: Copy

1.	陈峻青. 胃癌外科基础研究与扩大切除术的进展 [Ｊ]. 中国普外基础与临床杂志, 2004; 11（2）∶ 97.
2.	胡建昆, 陈佳平, 陈志新, 等. 胃癌外科切除治疗（附428例报告） [Ｊ]. 四川大学学报(医学版), 2003; 34(4)∶ 771.
3.	Edwards P, Blackshaw GR, Lewis WG, et al. Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma [Ｊ]. Br J Cancer, 2004; 90(10)∶1888.
4.	Shrikhande SV, Shukla PJ, Qureshi S, et al. D2 lymphadenectomy for gastric cancer in Tata Memorial Hospital: Indian data can now be incorporated in future international trials [Ｊ]. Dig Surg, 2006; 23(3)∶192.
5.	Barbour AP, Rizk NP, Gonen M, et al. Lymphadenectomy for adenocarcinoma of the gastroesophageal junction (GEJ): impact of adequate staging on outcome [Ｊ]. Ann Surg Oncol, 2007; 14(2)∶306.
6.	王吉甫主编. 胃肠外科学 [M]. 第1版. 北京: 人民卫生出版社, 2000∶ 360～415.
7.	Roviello F, Marrelli D, Morgagni P, et al. Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study [Ｊ]. Ann Surg Oncol, 2002; 9(9)∶894.
8.	Kosaka T, Usami K, Ueshige N, et al. Paraaortic lymph node dissection for gastric cancer in 244 consecutive cases [Ｊ]. Hepatogastroenterology, 2006; 53(70)∶629.
9.	Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage[Ｊ]. Ann Surg Oncol, 2007; 14(2)∶317.
10.	Wu CW, Hsiung CA, Lo SS, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial [Ｊ]. Lancet Oncol, 2006; 7(4)∶309.
11.	Kunisaki C, Akiyama H, Nomura M, et al. Comparison of surgical results of D2 versus D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric carcinoma: a multi-institutional study [Ｊ]. Ann Surg Oncol, 2006; 13(5)∶659.
12.	Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial [Ｊ]. J Clin Oncol, 2004; 22(11)∶2069.
13.	Bonenkamp JJ, Hermans J, Sasako M, et al. Dutch Gastric Cancer Group. Extended lymph-node dissection for gastric cancer [Ｊ]. N Engl J Med. 1999; 340(12)∶908.
14.	Maeta M, Yamashiro H, Saito H, et al. A prospective pilot study of extended (D3) and superextended para-aortic lymphadenectomy (D4) in patients with T3 or T4 gastric cancer managed by total gastrectomy [Ｊ]. Surgery, 1999; 125(3)∶325.
15.	Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group [Ｊ]. Br J Cancer, 1999; 79(9-10)∶1522.
16.	Sasako M. What is reasonable treatment for gastric adenocarcinoma? [Ｊ]. J Gastroenterology, 2000; 35(s12)∶116.
17.	Kulig J, Popiela T, Kolodziejczyk P, et al. Standard D2 versus extended D2 (D2+) lymphadenectomy for gastric cancer: an interim safety analysis of a multicenter, randomized, clinical trial[Ｊ]. Am J Surg, 2007; 193(1)∶10.
18.	Smith BR, Stabile BE. Aggressive D2 lymphadenectomy is required for accurate pathologic staging of gastric adenocarcinoma [Ｊ]. Am Surg, 2006; 72(10)∶849.
19.	Park SS, Park JM, Kim JH, et al. Prognostic factors for patients with node-negative gastric cancer: Can extended lymph node dissection have a survival benefit? [Ｊ]. J Surg Oncol, 2006; 94(1)∶16.
20.	Choi WH, Kim S, Shen J, et al. Prognostic significance of perinodal extension in gastric cancer [Ｊ]. J Surg Oncol, 2007;95(7)∶540.
21.	Marchet A, Mocellin S, Ambrosi A, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients [Ｊ]. Ann Surg, 2007; 245(4)∶543.
22.	Bunt AM, Hermans J, van de Velde CJ, et al. Lymph node retrieval in a randomized trial on western-type versus Japanese-type surgery in gastric cancer [Ｊ]. J Clin Oncol, 1996; 14(8)∶2289.
23.	Marubini E, Bozzetti F, Miceli R, et al. Lymphadenectomy in gastric cancer: prognostic role and therapeutic implications [Ｊ]. Eur J Surg Oncol, 2002; 28(4)∶406.
24.	Yoshikawa T, Sasako M, Sano T, et al. Stage migration caused by D2 dissection with para-aortic lymphadenectomy for gastric cancer from the results of a prospective randomized controlled trial [Ｊ]. Br J Surg, 2006; 93(12)∶1526.

1. 　陈峻青. 胃癌外科基础研究与扩大切除术的进展 [Ｊ]. 中国普外基础与临床杂志, 2004; 11（2）∶ 97.
2. 　胡建昆, 陈佳平, 陈志新, 等. 胃癌外科切除治疗（附428例报告） [Ｊ]. 四川大学学报(医学版), 2003; 34(4)∶ 771.
3. 　Edwards P, Blackshaw GR, Lewis WG, et al. Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma [Ｊ]. Br J Cancer, 2004; 90(10)∶1888.
4. 　Shrikhande SV, Shukla PJ, Qureshi S, et al. D2 lymphadenectomy for gastric cancer in Tata Memorial Hospital: Indian data can now be incorporated in future international trials [Ｊ]. Dig Surg, 2006; 23(3)∶192.
5. 　Barbour AP, Rizk NP, Gonen M, et al. Lymphadenectomy for adenocarcinoma of the gastroesophageal junction (GEJ): impact of adequate staging on outcome [Ｊ]. Ann Surg Oncol, 2007; 14(2)∶306.
6. 　王吉甫主编. 胃肠外科学 [M]. 第1版. 北京: 人民卫生出版社, 2000∶ 360～415.
7. 　Roviello F, Marrelli D, Morgagni P, et al. Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study [Ｊ]. Ann Surg Oncol, 2002; 9(9)∶894.
8. 　Kosaka T, Usami K, Ueshige N, et al. Paraaortic lymph node dissection for gastric cancer in 244 consecutive cases [Ｊ]. Hepatogastroenterology, 2006; 53(70)∶629.
9. 　Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage[Ｊ]. Ann Surg Oncol, 2007; 14(2)∶317.
10. 　Wu CW, Hsiung CA, Lo SS, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial [Ｊ]. Lancet Oncol, 2006; 7(4)∶309.
11. 　Kunisaki C, Akiyama H, Nomura M, et al. Comparison of surgical results of D2 versus D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric carcinoma: a multi-institutional study [Ｊ]. Ann Surg Oncol, 2006; 13(5)∶659.
12. 　Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial [Ｊ]. J Clin Oncol, 2004; 22(11)∶2069.
13. 　Bonenkamp JJ, Hermans J, Sasako M, et al. Dutch Gastric Cancer Group. Extended lymph-node dissection for gastric cancer [Ｊ]. N Engl J Med. 1999; 340(12)∶908.
14. 　Maeta M, Yamashiro H, Saito H, et al. A prospective pilot study of extended (D3) and superextended para-aortic lymphadenectomy (D4) in patients with T3 or T4 gastric cancer managed by total gastrectomy [Ｊ]. Surgery, 1999; 125(3)∶325.
15. 　Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group [Ｊ]. Br J Cancer, 1999; 79(9-10)∶1522.
16. 　Sasako M. What is reasonable treatment for gastric adenocarcinoma? [Ｊ]. J Gastroenterology, 2000; 35(s12)∶116.
17. 　Kulig J, Popiela T, Kolodziejczyk P, et al. Standard D2 versus extended D2 (D2+) lymphadenectomy for gastric cancer: an interim safety analysis of a multicenter, randomized, clinical trial[Ｊ]. Am J Surg, 2007; 193(1)∶10.
18. 　Smith BR, Stabile BE. Aggressive D2 lymphadenectomy is required for accurate pathologic staging of gastric adenocarcinoma [Ｊ]. Am Surg, 2006; 72(10)∶849.
19. 　Park SS, Park JM, Kim JH, et al. Prognostic factors for patients with node-negative gastric cancer: Can extended lymph node dissection have a survival benefit? [Ｊ]. J Surg Oncol, 2006; 94(1)∶16.
20. 　Choi WH, Kim S, Shen J, et al. Prognostic significance of perinodal extension in gastric cancer [Ｊ]. J Surg Oncol, 2007;95(7)∶540.
21. 　Marchet A, Mocellin S, Ambrosi A, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients [Ｊ]. Ann Surg, 2007; 245(4)∶543.
22. 　Bunt AM, Hermans J, van de Velde CJ, et al. Lymph node retrieval in a randomized trial on western-type versus Japanese-type surgery in gastric cancer [Ｊ]. J Clin Oncol, 1996; 14(8)∶2289.
23. 　Marubini E, Bozzetti F, Miceli R, et al. Lymphadenectomy in gastric cancer: prognostic role and therapeutic implications [Ｊ]. Eur J Surg Oncol, 2002; 28(4)∶406.
24. 　Yoshikawa T, Sasako M, Sano T, et al. Stage migration caused by D2 dissection with para-aortic lymphadenectomy for gastric cancer from the results of a prospective randomized controlled trial [Ｊ]. Br J Surg, 2006; 93(12)∶1526.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Significance and Surgical Skill for Lymphadenectomy Around Common Hepatic Artery in Gastric Cancer

Abstract Full text Figures/Tables Video References Cited by

Format

Content