Short-term and long-term efficacy of laparoscopic D2 lymphadenectomy combined with complete mesogastrium excision for locally advanced upper gastric cancer.

Abstract

The purpose of this article is to evaluate the short-term and long-term efficacy of laparoscopic D2 lymphadenectomy plus complete mesogastrium excision in treating locally advanced upper gastric cancer. We conducted a retrospective analysis of clinical data from 242 patients with locally advanced upper gastric cancer who underwent laparoscopic radical gastrectomy at the First Hospital of Putian in Fujian Province between January 2014 and August 2019. Short- and long-term outcomes were compared between the 2 groups. The D2 lymphadenectomy plus complete mesogastrium excision group demonstrated significantly less intraoperative blood loss (89.43 ± 74.66 mL vs 145.70 ± 63.20 mL, P < .001), a higher lymph node yield (42.91 ± 17.29 vs 37.10 ± 14.98, P = .008), and shorter postoperative recovery times (first flatus: 3 [2-3] vs 3 [3-3] days, P < .001; first liquid diet: 8 [7-8] vs 8 [7-9] days, P = .021; hospital stay: 14 [12-16] vs 15 [14-15] days, P = .035). Subgroup analysis showed significant overall survival and disease-free survival benefits for patients with stage T4a in the D2 lymphadenectomy plus complete mesogastrium excision group (P = .014 for both). Compared with D2 lymphadenectomy, laparoscopic D2 lymphadenectomy plus complete mesogastrium excision for locally advanced upper gastric cancer demonstrates significant advantages, including more extensive lymph node dissection, reduced blood loss, and faster postoperative recovery. Although no significant difference in overall survival was observed (P = .067), the D2 lymphadenectomy plus complete mesogastrium excision approach achieved lower local recurrence rates and superior 5-year disease-free survival. Notably, patients with stage T4a derived particular benefits from D2 lymphadenectomy plus complete mesogastrium excision, showing significantly improved long-term survival outcomes.