Mesenteric-guided approach to pyloric lymphadenectomy in laparoscopic radical gastrectomy

Table 1 Clinicopathological characteristics, surgical details, and pathological outcomes of patients, n (%)

Variables	D2 group (n = 165)	D2 + CME group (n = 165)	t/χ2/Z	P value
Clinicopathological feature
Male/female	112 (67.9)/53 (32.1)	114 (69.1)/51 (30.9)	0.056	0.813
Age (years), mean ± SD	65.87 ± 5.72	66.12 ± 5.59	-0.402	0.688
BMI (kg/m2), mean ± SD	22.15 ± 1.12	22.14 ± 1.04	0.084	0.933
ASA sore (I/II/III)	6 (3.6)/113 (68.5)/46 (27.9)	5 (3.0)/115 (69.7)/45 (27.3)	0.119	0.942
Comorbidities	82 (49.7)	84 (50.9)	0.012	0.912
Tumor position (upper/middle/lower/mix)	83 (50.3)/40 (24.2)/24 (14.5)/18 (11.0)	81 (49.1)/41 (24.9)/23 (13.9)/20 (12.1)	0.163	0.983
Surgical outcomes
Gastrectomy (total/distal)	137 (83.0)/28 (17.0)	141 (85.4)/24 (14.6)	0.205	0.650
Total operation time (minute), mean ± SD	301.25 ± 52.30	279.19 ± 45.50	4.088	< 0.001
Infrapyloric operative time (minute), mean ± SD	27.58 ± 4.20	22.24 ± 3.80	12.111	< 0.001
Infrapyloric bleeding loss (mL), mean ± SD	24.83 ± 6.35	4.71 ± 1.12	40.081	< 0.001
Postoperative recovery
Time of first postoperative flatus (days), Median (P25, P75)	4 (3, 5)	3 (3, 3)	0.251	0.874
Time of first liquid diet intake (days), Median (P25, P75)	8 (6, 10)	7 (5, 8)	0.107	0.809
Postoperative hospital stay (days), Median (P25, P75)	12 (11, 14)	11 (10, 12)	0.057	0.935
Pathologic results
Tumor size (cm), mean ± SD	4.82 ± 1.45	4.76 ± 1.38	0.668	0.505
Number of total LNs dissected, mean ± SD	37.25 ± 8.80	43.80 ± 10.05	-6.298	< 0.001
Number of No. 6 LNs dissected, mean ± SD	4.14 ± 0.41	5.26 ± 0.87	-14.959	< 0.001
pTNM stage1, (I/II/III)	19 (11.5)/55 (33.3)/91 (55.2)	21 (12.7)/61 (37.0)/83 (50.3)	0.778	0.678

¹According to the 8^th of gastric cancer staging, American Joint Committee on Cancer.

D2: D2 Lymphadenectomy; D2 + CME: D2 Lymphadenectomy plus complete mesogastric excision; BMI: Body mass index; ASA: American Society of Anesthesiologists; LNs: Lymph nodes; TNM: Tumor-node-metastasis.

Table 2 Postoperative complications following laparoscopic D2 Lymphadenectomy and D2 Lymphadenectomy plus complete mesogastric excision procedures, n (%)

Variables	D2 group (n = 165)	D2 + CME group (n = 165)	t/χ2/Z	P value
Number of complications	50 (30.3)	33 (20.0)	4.121	0.042
Anastomotic leakage	3 (1.8)	1 (0.6)	-	-
Lymphatic fistula	5 (3.0)	2 (1.2)	-	-
Pancreatic fistula	4 (2.4)	1 (0.6)	-	-
Abdominal cavity infection	6 (3.6)	1 (0.6)	-	-
Abdominal bleeding	7 (4.2)	4 (2.4)	-	-
Intestinal obstruction	3 (1.8)	1 (0.6)	-	-
Pulmonary infection	22 (13.3)	23 (13.9)	-	-
Clavien-Dindo classification III-IV	5 (3.0)	0 (0.0)	5.077	0.024

All complications in the D2 Lymphadenectomy and D2 Lymphadenectomy plus complete mesogastric excision group were Clavien-Dindo grade I-II and managed conservatively. In the D2 Lymphadenectomy group, five patients developed grade III-IV complications requiring surgical or interventional procedures. D2: D2 Lymphadenectomy; D2 + CME: D2 Lymphadenectomy plus complete mesogastric excision.