Objective To elucidate the correct anatomical dissection planes between the gastric mesentery and transverse mesocolon based on the concept of mesenteric anatomy, to evaluate its impact on complete mesogastric excision and No.4d lymph node dissection in gastric cancer surgery. Methods The clinical data of 62 patients who underwent laparoscopic D2 radical gastrectomy in the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Zhengzhou University from June 2023 to April 2024 were retrospectively analyzed. According to the different dissection methods of the gastric mesenteric space and the right transverse mesocolic space, they were divided into membrane dissection group (33 cases) and traditional dissection group (29 cases). The integrity of gastric mesangium in postoperative specimens of the two groups was observed, and the intraoperative mesangium free time, intraoperative blood loss, the number of lymph nodes dissection and postoperative complications in groups 6 and 4d were compared between the two groups. Follow-up was conducted by outpatient clinic, letter and telephone until September 1, 2024. Results All patients successfully completed laparoscopic surgery for gastric cancer, and there was no significant difference in general data between the two groups (P>0.05). Compared with the traditional dissection group, complete "envelope" mesengectomy was observed in the membrane dissection group, and the number of lymph node dissection was significantly increased (13.55±6.20 vs 4.69±1.74，P<0.001). There was no significant difference between the two groups in intraoperative bleeding, mesangial free time and the number of lymph nodes dissection in N0.6. No serious complications occurred in both groups. All patients in both groups were followed up for a median of 10 months (5-15 months). During the follow-up period, 1 patient in the traditional dissection group was found to have bilateral ovarian metastasis 11 months after surgery, and no patient died. Conclusions The correct dissection of the gastric mesangium and the right transverse mesocolic plane guided by the concept of membrane anatomy can safely obtain a more complete mesangectomy area and thorough dissection of N0.4d lymph nodes.
Key words
Gastric tumor /
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Lymph node dissection /
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Transverse mesocolon /
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Mesogastrium
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