title: Three-step method for systematic lymphadenectomy in gastric cancer surgery using the 'curettage and aspiration dissection technique' with Peng's multifunctional operative dissector.
abstract: BACKGROUND
  Gastric cancer is one of the most common malignancies and is a leading cause of cancer death worldwide. Surgery is the most effective and successful method of treatment for gastric cancer, and systematic lymph node (LN) dissection is unquestionably the most effective procedure for treating LN metastases of gastric cancer. Systematic lymphadenectomy is the most important part of curative resection, but lymphadenectomy is also the most difficult procedure in gastric cancer surgery. The aim of this study is to report our three-step method for lymphadenectomy in gastric cancer.
  
  
  METHODS
  In this study, the lymph node stations and groups were defined according to the 13th edition of the Japanese Classification for Gastric Carcinoma. The authors' novel, simplified method consists of three steps: (1) the Kocher maneuver and dissection of the greater omentum together with the anterior sheet of the mesocolon, (2) dissection of the lesser omentum, and (3) lymphadenectomy following the main vessels. We primarily used Peng's multifunctional operative dissector, which combines four different functions (cutting, separating, aspirating and coagulating). Our systematic lymphadenectomy included three steps, and the main procedure started from right to left and in the caudal to cranial direction.
  
  
  RESULTS
  A total of 830 consecutive patients underwent our three-step-method systematic lymphadenectomy in advanced gastric cancer surgery. The mean operation time was 146 minutes, and the mean blood loss was 248 ml. The median postoperative hospital stay was 10.9±4.8 days. The median number of examined LN was 31.6 (range 17 to 72) per patient, and the median number of metastatic LN was 5.6 (range 0 to 42) per patient. The overall incidence of postoperative complications was 10.6%, and the rate of hospital death was 0.9%. The overall three-year survival rate was 52.6%.
  
  
  CONCLUSIONS
  Our three-step method for lymphadenectomy is easy to perform and is a useful procedure for gastric cancer surgery.
authors.forename: Wenguang
authors.initials: W
authors.lastname: Wu
authors.forename: Ping
authors.initials: P
authors.lastname: Dong
authors.forename: Xiangsong
authors.initials: X
authors.lastname: Wu
authors.forename: Maolan
authors.initials: M
authors.lastname: Li
authors.forename: Qichen
authors.initials: Q
authors.lastname: Ding
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.forename: Jiahua
authors.initials: J
authors.lastname: Yang
authors.forename: Hao
authors.initials: H
authors.lastname: Weng
authors.forename: Qian
authors.initials: Q
authors.lastname: Ding
authors.forename: Zhujun
authors.initials: Z
authors.lastname: Tan
authors.forename: Jianhua
authors.initials: J
authors.lastname: Lu
authors.forename: Jun
authors.initials: J
authors.lastname: Gu
authors.affiliation: Department of General Surgery and Laboratory of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China. liuybphd@126.com.
authors.forename: Yingbin
authors.initials: Y
authors.lastname: Liu
mesh_terms: D003475:Curettage; D004210:Dissection / Q000295:instrumentation / Q000379:methods*; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision / Q000295:instrumentation / Q000379:methods*; D008207:Lymphatic Metastasis; D008646:Mesocolon / Q000601:surgery; D009852:Omentum / Q000601:surgery; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013396:Suction; D015996:Survival Rate; D016896:Treatment Outcome