J Korean Surg Soc.  2013 May;84(5):304-308.

Laparoscopy-assisted gastrectomy with para-aortic lymphadenectomy after palliative chemotherapy for advanced gastric cancer with isolated para-aortic lymph node metastasis

• Son SY
• Lee CM
• Lee JH
• Ahn SH
• Kim JW
• Lee KU
• Park DJ
• Kim HH

Abstract

Prophylactic para-aortic lymphadenectomy is not recommended in curable advanced gastric cancer. However, there are few reports on therapeutic para-aortic lymphadenectomy after palliative chemotherapy in far advanced gastric cancer. We report three cases of laparoscopy-assisted gastrectomy with para-aortic lymphadenectomy after palliative chemotherapy for the first time in Korea. Three gastric cancer patients with isolated para-aortic lymph node (PAN) metastasis showed partial response to capecitabine-based chemotherapy, and laparoscopy-assisted gastrectomy with para-aortic lymphadenectomy was performed with curative intent. The mean total operation time was 365 minutes (range, 310 to 415 minutes), and the mean estimated blood loss was 158 mL (range, 125 to 200 mL). The mean number of retrieved PAN was 9 (range, 8 to 11), and all pathologic results showed no metastasis of para-aortic region. All patients recovered and were discharged without any significant complications.

Keyword

Laparoscopy; Gastric cancer; Para-aortic lymphadenectomy

MeSH Terms

Gastrectomy
Humans
Korea
Laparoscopy
Lymph Node Excision
Lymph Nodes
Neoplasm Metastasis
Stomach Neoplasms

Figure

• 

  Fig. 1 Ports placement for laparoscopy-assisted total gastrectomy with para-aortic lymphadenectomy.

• 

  Fig. 2 (A) Completed 16a2 lymph node dissection. (B) Completed 16b1 lymph node dissection. (C) Specimen of para-aortic lymphadenectomy. IVC, inferior vena cava.

Reference

1. Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008. 359:453–462.

2. Oyama K, Fushida S, Kinoshita J, Makino I, Nakamura K, Hayashi H, et al. Efficacy of pre-operative chemotherapy with docetaxel, cisplatin, and S-1 (DCS therapy) and curative resection for gastric cancer with pathologically positive para-aortic lymph nodes. J Surg Oncol. 2012. 105:535–541.

3. Iwasaki Y, Ohashi M, Iwanaga T, Ohinata R, Takahashi K, Yamaguchi T, et al. Para-aortic lymph node dissection for far-advanced gastric cancer followed by chemotherapy. Gan To Kagaku Ryoho. 2012. 39:2319–2320.

4. Tanaka C, Kunieda K, Kawai M, Nagao N, Nishina T, Matsuhashi N, et al. Three cases of gastric cancer with para-aortic lymph node metastases succesfully treated by S-1/CDDP combination therapy followed by curative resection. Gan To Kagaku Ryoho. 2010. 37:1105–1109.

5. Kim H, Hyung WJ, Lim JS, Park MS, Choi JY, Chung YE, et al. Laparoscopic ultrasonography-assisted retroperitoneal lymph node sampling in patients evaluated for stomach cancer recurrence. J Ultrasound Med. 2008. 27:1229–1233.

6. Nakane Y, Okamura S, Masuya Y, Okumura S, Akehira K, Hioki K. Incidence and prognosis of para-aortic lymph node metastasis in gastric cancer. Hepatogastroenterology. 1998. 45:1901–1906.

7. Maeta M, Yamashiro H, Saito H, Katano K, Kondo A, Tsujitani S, et al. A prospective pilot study of extended (D3) and superextended para-aortic lymphadenectomy (D4) in patients with T3 or T4 gastric cancer managed by total gastrectomy. Surgery. 1999. 125:325–331.

8. Park IH, Kim SY, Kim YW, Ryu KW, Lee JH, Lee JS, et al. Clinical characteristics and treatment outcomes of gastric cancer patients with isolated para-aortic lymph node involvement. Cancer Chemother Pharmacol. 2011. 67:127–136.

9. Sym SJ, Chang HM, Ryu MH, Lee JL, Kim TW, Yook JH, et al. Neoadjuvant docetaxel, capecitabine and cisplatin (DXP) in patients with unresectable locally advanced or metastatic gastric cancer. Ann Surg Oncol. 2010. 17:1024–1032.

10. Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC. Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg. 2006. 202:874–880.