"Pancreas-Compressionless Gastrectomy": A Novel Laparoscopic Approach for Suprapancreatic Lymph Node Dissection.

BACKGROUND: In radical operations for gastric cancer, a balance between the quality of lymph node dissection and safety of surgery must be ensured. During suprapancreatic lymphadenectomy in laparoscopic gastrectomy (LG), an adequate operative field should be safely and effectively established to reduce pancreas-related complications. We present a novel approach that avoids direct compression of the pancreas in LG and describe the surgical outcomes of this method.

METHODS: We historically compressed the pancreas during suprapancreatic lymph node dissection in LG to obtain an adequate operative field but have since modified our operative technique. In our new method introduced in March 2016, the operative field is established by pulling and controlling the connective tissues along the inferior border of the pancreas and the nerves along the common hepatic and splenic arteries, instead of directly compressing the pancreas itself. We compared 51 patients in the compression group (January 2015-February 2016) and 45 patients in the compressionless group (March 2016-January 2017) in terms of surgical outcomes, including the amylase concentration in the drainage fluid and postoperative complications.

RESULTS: The amylase concentrations in the compressionless group were significantly lower on postoperative days 1 and 3 (p < 0.001 and p = 0.013, respectively) compared with the compression group. The rates of severe postoperative pancreatic fistula and intra-abdominal infectious complications decreased from 11.8 to 2.2% (p = 0.116) and from 17.6 and 2.2% (p = 0.018), respectively.

CONCLUSIONS: Our approach, termed "pancreas-compressionless gastrectomy," can be considered a safe and useful method to prevent postoperative infectious complications in LG.