Effect of Tailored Perigastric Lymph Node Dissection on Gastric Motility in a Canine Model.

ABSTRACT

BACKGROUND: Combination laparoscopic lymph node (LN) dissection and endoscopic resection is a promising treatment for early gastric cancer. However, LN dissection could cause nerve injury and deterioration of motility in the preserved stomach. This experimental study aims to evaluate changes in gastric motility after tailored perigastric regional lymph node dissection without gastrectomy. MATERIALS AND METHODS: We identified four most frequently involved LN combinations considering tumor location from retrospective reviews of 4697 gastrectomy patients. We randomly assigned 55 dogs to five groups control (laparotomy only) and four experimental groups with LN dissection without gastrectomy group 1 (LNs 3, 7, and 8), group 2 (LNs 3, 4, and 6), group 3 (LNs 1, 3, and 7), and group 4 (LNs 3, 4, and 11). Gastric emptying time (GET) was measured using barium-impregnated polyethylene spheres. GET50 and GET75 were the time points when 50% and 75% of the markers, respectively, had emptied from the stomach. RESULTS: On postoperative days (PODs) 2 and 3, GET50, GET75, and proportion of GET50 <4 h in groups 1 and 2 were comparable with controls. However, group 3 showed delayed GET50 and GET75, and groups 3 and 4 demonstrated significantly smaller proportions of GET50 <4 h compared with controls on PODs 2 and 3. This effect resolved by POD 6 and there were no significant differences in GET50, GET75, or proportion of GET50 <4 h between the groups. CONCLUSIONS: Tailored perigastric LN resection without gastrectomy was feasible and acceptable in terms of postoperative motility in the preserved stomach.