Effect of Tailored Perigastric Lymph Node Dissection on Gastric Motility in a Canine Model

초록

Background: Combination laparoscopic lymph node (LN) dissection and endoscopic resection is a promising treatment for early gastric cancer. However, LN dissection could cause nerve injury and deterioration of motility in the preserved stomach. This experimental study aims to evaluate changes in gastric motility after tailored perigastric regional lymph node dissection without gastrectomy. Materials and methods: We identified four most frequently involved LN combinations considering tumor location from retrospective reviews of 4697 gastrectomy patients. We randomly assigned 55 dogs to five groups: control (laparotomy only) and four experimental groups with LN dissection without gastrectomy: group 1 (LNs 3, 7, and 8), group 2 (LNs 3, 4, and 6), group 3 (LNs 1, 3, and 7), and group 4 (LNs 3, 4, and 11). Gastric emptying time (GET) was measured using barium-impregnated polyethylene spheres. GET(50) and GET(75) were the time points when 50% and 75% of the markers, respectively, had emptied from the stomach. Results: On postoperative days (PODs) 2 and 3, GET(50), GET(75), and proportion of GET(50) <4 h in groups 1 and 2 were comparable with controls. However, group 3 showed delayed GET(50) and GET(75), and groups 3 and 4 demonstrated significantly smaller proportions of GET(50) <4 h compared with controls on PODs 2 and 3. This effect resolved by POD 6 and there were no significant differences in GET(50), GET(75), or proportion of GET(50) <4 h between the groups. Conclusions: Tailored perigastric LN resection without gastrectomy was feasible and acceptable in terms of postoperative motility in the preserved stomach. (C) 2019 Elsevier Inc. All rights reserved.

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