Stomach resection with intraoperative fluoroscopy in laparoscopic distal gastrectomy for early gastric cancer
Jun Kawachi1, Hiroyuki Kashiwagi1, Hidemitsu Ogino1, Naoko Isogai1, Rai Shimoyama1, Ryuta Fukai1, Katsunori Miyake1, Akiko Sasaki2, Takahiro Terashima3, Shinichi Teshima4, Kazunao Watanabe5
1 Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
2 Gastroenterology Center, Shonan Kamakura General Hospital, Kamakura, Japan
3 Department of Surgery, Shonan Atsugi Hospital, Atsugi, Japan
4 Department of Pathology, Shonan Kamakura General Hospital, Kamakura, Japan
5 Department of Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
Department of Surgery, Shonan Kamakura General Hospital, Kamakura
Source of Support: None, Conflict of Interest: None
Background: In Japan, laparoscopic distal gastrectomy (LDG) is common for early gastric cancer. Formerly, we used to verify the location of the marking clip to decide the proximal incisional line with our hand, through a small epigastric incision. In 2015, we introduced intracorporeal reconstruction and started to decide the incisional line using intraoperative fluoroscopy. Herein, we aimed to evaluate the efficacy and safety of intraoperative fluoroscopy in LDG.
Patients and Methods: A total of 19 patients were included in this retrospective observational study. On the day before operation, we endoscopically clipped several points located 2 cm proximal to the tumour edge to cover about half of the tumour. After lymph node dissection, we incised the stomach with an endoscopic linear stapling device, including the previously placed clips, guided by intraoperative fluoroscopy. Reconstruction was performed in all patients who underwent Billroth I and Roux-en-Y procedures.
Results: No complications were observed during pre-operative endoscopic clipping or intraoperatively. On pathological examination, all resected specimens had negative margins, and the mean distance from the tumour edge was 28.5 ± 16.5 (13–60) mm.
Conclusion: Stomach resection with intraoperative fluoroscopic guidance was safe and effective.