Laparoscopy-assisted D2 radical distal subtotal gastrectomy

The laparoscopic surgery for gastric cancer has been a hot spot in the development of gastric cancer surgery during recent years. The perigastric lymph nodes were divided into five regions and then dissected by laparoscopy in our hospital, according to the extent of lymph node resection of D2 gastric cancer surgery specified in the Japanese Surgical Guidelines for Stomach Cancer and the Japanese Gastric Cancer Treatment Protocols (14th edition ): (I) the peripheral lymph nodes of gastro-omental vessels in the left and lower region of the stomach (stations 4d and 4sb); (II) the peripheral lymph nodes of the inferior pylorus and superior mesenteric vein in the right and lower stomach (stations 15, 14v, and 6); (III) the lymph nodes in the right and upper stomach (station 5 in the superior pylorus and station 12a in the hepatoduodenal ligament); (IV) the lymph nodes distributed in the central region of the pancreatic body, celiac axis and three branches (stations 7, 8a, 9, and 1lp); and (V) the lymph nodes distributed along the lesser curvature (stations 1, 3 and 5). The lymph nodes were dissected and the stomach was dissociated from the lower side to the upper side and from left to right. The duodenal stump, greater curvature and lesser curvature were transected and closed with Endo-GIA. The specimen was collected through a small incision under xiphoid. The digestive tract was reconstructed by RouX-en-Y gastrojejunostomy under direct vision, followed by incision suture.