Laparoscopic distal gastrectomy with nodal dissection for clinical stage I gastric cancer

In recent years, the number of patients undergoing laparoscopic gastrectomy has risen globally. This is due to the low invasiveness of laparoscopic surgery and the quick recovery of patients after surgery. However, the effectiveness of laparoscopic gastrectomy for advanced gastric cancer has not been verified. In fact, it is often difficult to perform lymphadenectomy for advanced gastric cancer because this procedure requires dissection of lymph nodes only, with avoidance of damage to structures such as the pancreas and blood vessels, which are intertwined in the same area. This is clearly difficult from a technical standpoint. For these reasons, it is unlikely that the indication for laparoscopic gastrectomy for advanced gastric cancer will expand. In this report, we describe lymphadenectomy and reconstruction in routine laparoscopic gastrectomy. It is possible to apply techniques such as the lateral ap-proach for station 6, the crossover method for dissection of lymph nodes on the superior margin of the pancreas, and Delta anastomosis, which is a reconstruction using the intra-corporeal Billroth I method, for advanced cancer. All of these methods are simple, reliable, and safe, and we hope that their description in this report will be useful to both junior surgeons and those with long experience in this field.