Clinical efficacy of the superior pancreatic region approach guided by pancreatic capsule in laparoscopic radical gastrectomy of 438 patients

Objective To investigate the clinical efficacy of the superior pancreatic region approach guided by pancreatic capsule in laparoscopic radical gastrectomy of 438 patients. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 438 patients who underwent laparoscopic radical gastrectomy of gastric cancer in the Second Hospital of Jilin University between April 2013 and April 2017 were collected. Patients were confirmed with stage T2 and above by postoperative pathological examination and then underwent adjuvant chemotherapy of XELOX regimen. Observation indicators: (1) surgical situation; (2) postoperative recovery situation; (3) postoperative pathological examination; (4) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative adjuvant chemotherapy, postoperative long-term complications and tumor metastasis or recurrence up to May 2017. Measurement data with normal distribution were represented as ±s. Results (1) Surgical situation: all the 438 patients underwent laparoscopic radical gastrectomy of gastric cancer through the superior pancreatic region approach guided by pancreatic capsule, including 295 undergoing distal gastrectomy and 143 undergoing total gastrectomy. There were no conversion to open surgery. Operation time and volume of intraoperative blood loss were respectively (178±32) minutes and (39±11)mL. There were no intraoperative complications and death in perioperative period. (2) Postoperative recovery situation: time to anal exsufflation, time for fluid diet intake and duration of hospital stay were (32±6)hours, (26±3)hours and (8.7±2.3)days, respectively. Volume of amylase drainage was (157±35)U/L at postoperative day 1, (68±25)U/L at postoperative day 2 and (43±17)U/L at postoperative day 3, respectively. No pancreatic fistula occurred postoperatively. (3) Postoperative pathological examination: results of postoperative pathological examination showed that 218, 209 and 11 patients were detected in T2, T3 and T4a staging, respectively. Numbers of lymph node dissected and lymph node metastases were respectively 27.0±6.0 and 4.2±2.9. Pathological typing: high- or moderate-differentiated adenocarcinoma, low-differentiated adenocarcinoma and undifferentiated carcinoma or signet-ring cell carcinoma were detected in 67, 279 and 92 patients, respectively. (4) Follow-up situation: of 438 patients, 415 were followed up for 1-48 months, with a median time of 33 months of 438 patients, 293 received postoperative adjuvant chemotherapy of XELOX regimen, 122 received unknown adjuvant chemotherapy or refused chemotherapy. During the follow-up, there was no occurrence of tumor-related complications, 13 patients had tumor metastases or recurrence and 5 patients died of tumor recurrence or metastases. Conclusion The superior pancreatic region approach guided by pancreatic capsule is safe and feasible in laparoscopic radical gastrectomy. Key words: Gastric neoplasms; Pancreatic capsule; Radical gastrectomy; Laparoscopy