Laparoscopically assisted total or distal gastrectomy with lymph node dissection for early gastric cancer

Background: A secure lymphadenectomy in a laparoscopically assisted gastrec tomy performed for gastric cancer is required because of the high prevalenc e of lymph node metastasis. A surgical technique for laparoscopic gastrecto my with lymph node dissection and reconstruction using a conventional circu lar stapler is reported. Methods: Forty-nine laparoscopically assisted gastrectomies with lymphadene ctomy (47 distal and two total gastrectomies) were performed using devices for retraction of the stomach and laparoscopic ligation of arteries, which were developed to ensure secure dissection of lymph nodes. Reconstruction b y Billroth I or intestinal interposition using a conventional circular stap ler was performed through a small incision through which the specimen was r emoved. When submucosal invasion was suspected (n = 16), the lymph nodes al ong with the common hepatic artery were also dissected through the same inc ision. Results: The operations were performed without serious complication. None w as converted to laparotomy, and there were no deaths. Metastatic lymph node s were seen in perigastric nodes and nodes along the left gastric artery in five cases. In five of the 49 patients the macroscopic diagnosis of depth of invasion was underestimated. Conclusion: A technique of laparoscopic gastrectomy with lymph node dissect ion for early invasive gastric cancer is described. A definitive answer con cerning the appropriate level of lymph node dissection and the role of lapa roscopic gastrectomy in the treatment of more advanced gastric cancer remai ns to be defined.