Pan GF, Zhang WH, Cai ZM, Chen J, Wu JH, Weng JB, Zhu ZP, Guo ZX, Lin JJ, Li ZX, Xu YC. Mesenteric-guided approach to pyloric lymphadenectomy in laparoscopic radical gastrectomy. World J Gastrointest Surg 2025; 17(9): 110064 [DOI: 10.4240/wjgs.v17.i9.110064]
Corresponding Author of This Article
Yan-Chang Xu, Department of Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, No. 449 Nanmen West Road, Chengxiang District, Putian 351100, Fujian Province, China. xyc202301@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Guo-Feng Pan, Wei-Hong Zhang, Zhi-Ming Cai, Jian Chen, Ji-Huang Wu, Jian-Bin Weng, Zi-Peng Zhu, Zhi-Xing Guo, Jian-Jin Lin, Zhi-Xiong Li, Yan-Chang Xu, Department of Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian 351100, Fujian Province, China
Guo-Feng Pan, Department of Gastroenterological Surgery Unit 1, Putian First Hospital, The Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
Guo-Feng Pan, Department of Gastrointestinal Surgery, Institute of Minimally Invasive Surgery of Putian University, Putian 351100, Fujian Province, China
Co-first authors: Guo-Feng Pan and Wei-Hong Zhang.
Author contributions: Pan GF and Zhang WH contributed equally to this article, they are the co-first authors of this manuscript; Pan GF, Zhang WH, and Xu YC designed the research study; Cai ZM, Chen J, Wu JH, Weng JB, Zhu ZP, Guo ZX, and Lin JJ performed the research; Pan GF, Zhang WH, and Li ZX analyzed the data and wrote the manuscript; Xu YC supervised the project; and all authors have read and approved the final manuscript.
Supported by the Natural Science Foundation Program in Fujian Province of China, No. 2023J011726.
Institutional review board statement: This study was approved by the Medical Ethics Committee of First Hospital of Putian Cit, approval No. 2024-180.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at xyc202301@163.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Chang Xu, Department of Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, No. 449 Nanmen West Road, Chengxiang District, Putian 351100, Fujian Province, China. xyc202301@163.com
Received: May 28, 2025 Revised: June 16, 2025 Accepted: August 1, 2025 Published online: September 27, 2025 Processing time: 119 Days and 0.7 Hours
Abstract
BACKGROUND
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.
AIM
To propose a mesentery-based strategy for infrapyloric lymphadenectomy and evaluate its safety, feasibility, and efficacy.
METHODS
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 excision (D2 + CME) and 165 matched controls receiving conventional D2.
RESULTS
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).
CONCLUSION
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.
