Delayed gastric emptying after surgery for transverse colon cancer: diagnosis, management and prevention / 中华胃肠外科杂志

Delayed gastric emptying is a syndrome of gastric motility disorder with slow gastric emptying as the main sign, provided that mechanical factors such as intestinal obstruction and anastomotic stricture are excluded. The incidence of delayed gastric emptying after colon cancer surgery is 1.4%, mainly after transverse colon cancer surgery. Most of the studies on delayed gastric emptying are case reports, lacking systematic studies. The diagnoses and treatments can be draw on the experience of delayed gastric emptying after pancreatic surgery. Our retrospective study indicated that the incidence of delayed gastric emptying after surgery for transverse colon cancer was 4.0%, higher than that for other colon cancer. Patients who underwent gastrocolic ligament lymph node dissection were at higher risk than those who did not (3.6% vs. 0.8%). Gastrocolic ligament lymph node dissection and stress are causative factors for delayed gastric emptying after surgery for transverse colon cancer. We add the gastrografin test upon the diagnostic criteria of the International Study Group for Pancreatic Surgery, which is simple and practical. Nasogastric tube decompression, enteral nutrition combined with parenteral nutrition, glucocorticoids, and prokinetic agents can cure most patients with postoperative delayed gastric emptying. All the patients with postoperative delayed gastric emptying were cured in our studies. Strict indications for gastrocolic ligament lymph node dissection (patients with cT3-4 and cN+) may decrease the occurrence of delayed gastric emptying after surgery for transverse colon cancer.

Infrapyloric lymph node dissection in 4K laparoscopic radical gastrectomy / 中华消化外科杂志

The unique multi perspective and magni-fying effect of laparoscopic surgery make gastric surgery more precise and minimally invasive. The technical innovation of 4K laparoscopy enable surgeons to understand the finer submicrostructure-membrane anatomy. The advantages of perigastric lymph node dissection with less trauma and bleeding under the guidance of membrane anatomy theory are widely recognized. As a common metastatic site of advanced distal gastric cancer, lymph nodes in the infrapyloric region play an important role in radical gastrectomy. Blood vessels variation is common in the inferior pyloric region, and the layer between gastric and mesenteric membrane is complex. Complete resection of the right gastric omentum membrane can yield greater surgical benefits. In this article, the author discuss the key points of lymph node dissection in the subpyloric region based on their surgical experience, aiming to promote the standard surgical procedure of 4K laparoscopic lymph node dissection in the inferior pyloric region based on membrane anatomy.