Laparoscopic Perigastric Mesogastrium Excision Technique for Radical Total Gastrectomy

Introduction: Complete mesogastrium excision ([CME) of the perigastric mesogastrium and dissection of lymph nodes (LNs) no. 10 and no. 11 remain technically challenging aspects of laparoscopic radical total gastrectomy (LRTG) plus CME. To address some of these difficulties, we introduced the laparoscopic perigastric mesogastrium excision technique (LPMET) and the concept of the "enjoyable space" to partly modify the procedures of conventional radical surgery and characterize the perigastric space and the surgical plane as well as its boundaries. Aim: To introduce the laparoscopic perigastric mesogastrium excision technique (LPMET) and the "enjoyable space" when undergoing laparoscopic radical total gastrectomy. Material and methods: From July 2016 to June 2017, 79 cases of upper gastric cancer that were treated by laparoscopic D2 gastrectomy plus CME were investigated. The retrospective database included the patient characteristics, intraoperative and postoperative outcomes, and morbidity and mortality rates depending on the completeness of their medical records. Results: Laparoscopic D2 gastrectomy plus CME was successfully performed in all 79 cases. The mean surgical time was 232.5 +/- 46.0 min, and the intraoperative blood loss was 67.6 +/- 52.3 ml. A total of 2245 LNs were retrieved (mean 28.1 +/- 10.8 retrieved from each specimen). The mean postoperative hospital stay was 10.3 +/- 1.6 days. The postoperative morbidity rate was 17.7%. After a median follow-up period of 12 months, one patient experienced liver metastasis; of the other 78 patients, none died or experienced tumor recurrence or metastasis. Conclusions: Laparoscopic perigastric mesogastrium excision technique and the "enjoyable space" could be a novel, minimally invasive approach and space to achieve CME and provide benefit for the dissection of LNs no. 10 and no. 11.