Extent of lymph node dissection and interpretation of technical standards for 4K laparoscopic proximal gastrectomy in gastric cancer / 中华消化外科杂志

ABSTRACT

Laparoscopic gastrectomy has been widely applied in the surgical treatment for gastric cancer. The indications of laparoscopic gastrectomy for gastric cancer are also expanding. Based on the results of CLASS-01 study, laparoscopic distal gastrectomy is one of standard recommended surgical procedures for locally advanced gastric cancer. With the increased incidence of proximal gastric cancer and adenocarcinoma of esophagogastric junction, the proportion of total and proximal gastrectomy is gradually increasing. However, in consideration of tumor recurrence risk and severe gastroesophageal reflux symptoms after operation, the indication for proximal gastrectomy is more rigorous. Considering the minimally invasive advantage of laparoscopy, laparoscopic proximal gastrectomy is still an alternative surgical method for patients with surgical indications. It is well known that lymphadenectomy is the key procedure in stan-dard radical gastrectomy for gastric cancer. According to the Japanese gastric cancer treatment guideline of Japanese Gastric Cancer Association (JACA), the standard surgery of proximal gastrectomy is proximal gastrectomy combined with D 1 (No.1, 2, 3a, 4sa, 4sb, 7) or D 1+ (D 1+ No.8a, 9, 11p) lymphadenectomy. The authors describe the extent and procedure of lymphadenectomy and interpret technical standards for laparoscopic proximal gastrectomy.