Published online Sep 27, 2025. doi: 10.4240/wjgs.v17.i9.110064
Revised: June 16, 2025
Accepted: August 1, 2025
Published online: September 27, 2025
Processing time: 119 Days and 0.7 Hours
Lymphadenectomy of the infrapyloric region remains technically demanding in laparoscopic radical gastrectomy. Traditional vessel-guided approaches often result in incomplete dissection and higher complication rates, especially at station No. 6.
To propose a mesentery-based strategy for infrapyloric lymphadenectomy and evaluate its safety, feasibility, and efficacy.
By identifying key anatomical landmarks and defining the inferior mesenteric boundary of the pyloric region (right gastro-omental mesentery), this approach enables full exposure and en bloc resection of anterior and posterior mesenteric planes, with proximal ligation at the root of feeding vessels. A retrospective cohort study was conducted on 330 gastric cancer patients who underwent D2 lymphadenectomy (D2) from January 2020 to December 2021. Outcomes were compared between 165 patients treated with D2 plus complete mesogastric ex
The D2 + CME group demonstrated significantly improved surgical outcomes, including shorter total operative time (279.19 ± 45.50 minutes vs 301.25 ± 52.30 minutes, P < 0.001), reduced infrapyloric dissection time (22.24 ± 3.80 minutes vs 27.58 ± 4.20 minutes, P < 0.001), and lower blood loss (4.71 ± 1.12 mL vs 24.83 ± 6.35 mL, P < 0.001). More lymph nodes were retrieved overall (43.80 ± 10.05 vs 37.25 ± 8.80, P < 0.001), particularly at station No. 6 (5.26 ± 0.87 vs 4.14 ± 0.41, P < 0.001). Postoperative recovery indicators and hospital stay were comparable between groups, while the complication rate was significantly lower in the D2 + CME group (20% vs 30.3%, P = 0.042).
The mesentery-based approach enables safe pyloric lymphadenectomy. Systematic mesogastric excision improves operative efficiency and lymph node yield, especially at station No. 6, offering potential oncological benefits in gastric cancer surgery.
Core Tip: This study introduces a mesentery-guided approach to pyloric lymphadenectomy in laparoscopic gastrectomy, centered on defining anatomical landmarks within the right gastro-omental mesentery. By integrating complete mesogastric excision into the standard D2 dissection, this technique enhances the retrieval of No. 6 lymph nodes, reduces operative time and blood loss, and significantly lowers postoperative complication rates. The standardized procedure provides both surgical precision and oncologic potential, offering a valuable strategy for improving outcomes in minimally invasive gastric cancer surgery.