Objective To study the necessity and feasibility of No.12b lymph node dissection in D2 lymphadenectomy for advanced distal gastric cancer, and the relation between No.12b lymph node metastasis and clinicopathologic factors. Methods Clinical data of sixty cases of advanced distal gastric cancer receiving D2 or D2+ radical correction were collected retrospectively, both of which were all plus No.12b lymph node dissections. The relationships between No.12b lymph node metastasis and clinicopathologic factors were analyzed. Results No death attributed to operation or severe operative complications were found. There were 12 cases (20.00%) with No.12b lymph node metastasis. The rates of No.12b lymph node metastasis in Borrmann Ⅲ-Ⅳ types, N2-3 of lymph node metastasis and T3-4 of tumor infiltration were 31.25% (10/32), 30.30% (10/33) and 29.73% (11/37), which were significantly higher than those in Borrmann Ⅰ-Ⅱ types 〔7.14% （2/28）〕, N0-1 〔7.41% （2/27）〕 and T1-2 〔4.35% （1/23）〕 respectively (Plt;0.05). There was no relationship between tumor size and No.12b lymph node metastasis. Conclusions No.12b lymph node dissection is safe and feasible for advanced distal gastric cancer. Further perspective studies on No.12b lymph node dissection influence on prognosis in more cases are required.
ObjectiveTo systemically evaluate safety and effectiveness of laparoscopy-assisted distal gastrectomy (LADG) and conventional open distal gastrostomy(CODG) with D2 lymph node dissection for Chinese patients with distal gastric cancer. MethodsLiterature were searched in PubMed database, the Cochrane Library, China science citation database (CSCD), Wanfang database, China science and technology journal database (CSTJ), China biomedical literature database (CBM), and China academic journal network publishing database (CAJD) to identify clinical random controlled trials, comparing safety and effectiveness of LADG and CODG with D2 lymph node dissection for Chinese patients with distal gastric cancer. The retrieval time was from the inception to Jun. 2013. Meta-analysis was performed by Review Manager 5.2 software. ResultsA total of 7 clinical random controlled trials including 548 patients were analyzed. Compared with CODG group, LADG group had less blood loss (MD=-94.02, 95% CI:-140.96--47.07), shorter postoperative hospital stay(MD=-3.66, 95% CI:-5.76--1.57), earlier postoperative ambulation time(MD=-1.95, 95% CI:-2.74--1.17), earlier postoperative exhaust time (MD=-1.67, 95% CI:-2.05--1.30), lower incidence of complications(OR=0.26, 95% CI:0.14-0.51), P<0.050. But the operation time was longer in LADG group (MD=35.01, 95% CI:10.41-59.61, P=0.005). There was no significant difference between LADG group and CODG group on number of lymph node which were dissected during the operation (MD=-0.24, 95% CI:-0.99-0.51, P=0.530). ConclusionThe short-term outcome and safety of LADG for Chinese patients with distal gastric cancer is superior to CODG, but LADG prolongs the operation time and its long-term outcome should be proved by further outcomes of clinical controlled trials.