title: Clinical significance of medial approach for suprapancreatic lymph node dissection during laparoscopic gastric cancer surgery.
abstract: OBJECTIVE
  Suprapancreatic lymph node dissection is critical for gastric cancer surgery. Beginning in 2010, a medial approach was adopted for suprapancreatic lymph node dissection during laparoscopic gastrectomy for distal gastric cancer in our institution. The aim of this study was to compare surgical outcomes of the medial approach and conventional approach in laparoscopic gastric surgery.
  
  
  METHODS
  Between January 2007 and December 2012, a total of 100 patients with clinical T1 or T2 tumors underwent laparoscopic distal gastrectomy involving suprapancreatic lymph node dissection by the medial approach (n = 44) and conventional approach (n = 56) with curative intent. The comparison was based on clinicopathological characteristics and surgical outcome.
  
  
  RESULTS
  The laparoscopic procedure was not converted to laparotomy in any patient. The patients' demographics and tumor characteristics did not show any statistically significant difference, except for tumor location. In the conventional approach group, the tumors were at a higher position (p = 0.037) and more frequently received Roux-en-Y reconstruction (p < 0.001). Intracorporeal anastomosis was significantly more common in the medial approach group (p < 0.001). Compared with the conventional approach, the medial approach was associated with significantly less operative blood loss (p < 0.001), more retrieved suprapancreatic lymph nodes (p = 0.019), and a shorter hospital stay (p = 0.018). The rates of complications were comparable between the two groups.
  
  
  CONCLUSIONS
  This study suggests that the medial approach to suprapancreatic lymph node dissection seems to be convenient and useful in laparoscopic gastric cancer surgery.
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan, shinohara@jikei.ac.jp.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shinohara
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Hanyu
authors.forename: Susumu
authors.initials: S
authors.lastname: Kawano
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Keishiro
authors.initials: K
authors.lastname: Murakami
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000368:Aged; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D010179:Pancreas; D010529:Peritoneal Cavity; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*