Objective: To investigate the application value of vessel-guided lymph node dissection in laparoscopic radical gastrectomy for gastric cancer.
Methods: The clinical data of 84 patients with advanced gastric cancer undergoing laparoscopic radical gastrectomy were retrospectively analyzed. Of the patients, 42 underwent vessel-guided lymph node dissection (observation group) and 42 cases underwent conventional systemic lymph node dissection (control group) during operation. The serum levels of matrix metalloproteinases (MMPs), vascular endothelial growth factor (VEGF), kallikreins 7 (KLK7), E-cadherin (E-cad) were determined, and the blood and peritoneal micrometastasis were also detected via examining the mRNA levels of carcinoembryonic antigen (CEA) and cytokeratin 19 (CK-19) in the peripheral blood and peritoneal washes.
Results: There were no significant differences in number of dissected lymph nodes, distance between incision margin and tumor, time to postoperative anus gas passage, length of hospital stay and incidence of complications between the two groups (all P>0.05). The operative time and intraoperative blood loss in observation group were significantly decreased compared with control group (both P<0.05). The serum levels of MMP-2, MMP-9, VEGF and KLK7 were significantly decreased and E-cad was significantly increased in both groups after operation, but the decreasing amplitudes of MMP-9, VEGF and KLK7 in observation group were significantly greater than those in control group (all P<0.05). The blood and peritoneal micrometastasis rates showed no significant differences between the two groups before operation (both P>0.05), but were significantly lower in observation group than those in control group after operation (both P<0.05). The overall incidence of postoperative recurrence/metastasis in observation group was significantly lower and the progression-free survival was significantly longer in observation than those in control group (both P<0.05), but there were no significant differences in the overall survival and 1- and 3-year survival rate between the two groups (all P>0.05).
Conclusion: Using vessel-guided lymph node dissection in laparoscopic radical gastrectomy for gastric cancer can shorten the operative time and reduce intraoperative bleeding, and also it may improve long-term prognosis of the patients by reducing the risk of micrometastasis.