Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Feasibility of Vascular Navigation System During Laparoscopic Gastrectomy for Gastric Cancer: A Retrospective Comparison With Propensity-Score Matching

  • Ji Eun Jung (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Jeong Ho Song (Department of Surgery, Ajou University School of Medicine) ;
  • Seyeol Oh (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Sang-Yong Son (Department of Surgery, Ajou University School of Medicine) ;
  • Hoon Hur (Department of Surgery, Ajou University School of Medicine) ;
  • In Gyu Kwon (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Sang-Uk Han (Department of Surgery, Ajou University School of Medicine)
  • Received : 2024.05.27
  • Accepted : 2024.06.26
  • Published : 2024.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The usability of a new surgical navigation system that provides patient-specific vascular information for robotic gastrectomy in gastric cancer remains unexplored for laparoscopic gastrectomy owing to differences in surgical environments. This study aimed to evaluate the applicability and safety of this navigation system in laparoscopic gastrectomy and to compare the post-operative outcomes between procedures with and without its use. Materials and Methods: Between June 2022 and July 2023, 38 patients across 2 institutions underwent laparoscopic gastrectomy using a navigation system (navigation group). The technical feasibility, safety, and accuracy of detecting variations in vascular anatomy were measured. The perioperative outcomes were compared with 114 patients who underwent laparoscopic gastrectomy without a navigation system (non-navigation group) using 1:3 propensity score matching during the same study period. Results: In all patients in the navigation group, no adverse events associated with the navigation system occurred during surgery in any patient in the navigation group. No accidental vessel injuries necessitate auxiliary procedures. All vessels encountered during the gastrectomy were successfully reconstructed and visualized. Patient demographics and operative data were comparable between the 2 groups. The navigation group exhibited a significantly lower overall complication rate (10.5%) than the non-navigation group (26.3%, P=0.043). Notably, pancreas-related complications were absent in the navigation group but occurred in eight cases in the non-navigation group (7.0%, P=0.093), although the difference was not statistically significant. Conclusions: The patient-specific surgical navigation system demonstrated clinical feasibility and safety for laparoscopic gastrectomy for gastric cancer, potentially reducing complication rates compared with laparoscopic gastrectomy without its use.

Keywords

Acknowledgement

We would like to thank Editage (www.editage.co.kr) for their assistance with English language editing.

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-249.
  2. Mocellin S. The effect of lymph node dissection on the survival of patients with operable gastric carcinoma. JAMA Oncol 2016;2:1363-1364.
  3. Kim TH, Kim IH, Kang SJ, Choi M, Kim BH, Eom BW, et al. Korean Practice Guidelines for Gastric Cancer 2022: an evidence-based, multidisciplinary approach. J Gastric Cancer 2023;23:3-106.
  4. Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer 2023;26:1-25.
  5. Kim YM, Son T, Kim HI, Noh SH, Hyung WJ. Robotic D2 lymph node dissection during distal subtotal gastrectomy for gastric cancer: toward procedural standardization. Ann Surg Oncol 2016;23:2409-2410.
  6. Kim YM, Baek SE, Lim JS, Hyung WJ. Clinical application of image-enhanced minimally invasive robotic surgery for gastric cancer: a prospective observational study. J Gastrointest Surg 2013;17:304-312.
  7. Park SH, Kim KY, Kim YM, Hyung WJ. Patient-specific virtual three-dimensional surgical navigation for gastric cancer surgery: a prospective study for preoperative planning and intraoperative guidance. Front Oncol 2023;13:1140175.
  8. Liu P, Wei M, Sun D, Zhong X, Liang Y, Ouyang J, et al. Study on the application of preoperative three-dimensional CT angiography of perigastric arteries in laparoscopic radical gastrectomy. Sci Rep 2022;12:6026.
  9. Kumano S, Tsuda T, Tanaka H, Hirata M, Kim T, Murakami T, et al. Preoperative evaluation of perigastric vascular anatomy by 3-dimensional computed tomographic angiography using 16-channel multidetector-row computed tomography for laparoscopic gastrectomy in patients with early gastric cancer. J Comput Assist Tomogr 2007;31:93-97.
  10. Matsuki M, Kanazawa S, Kanamoto T, Inada Y, Kani H, Tanikake M, et al. Virtual CT gastrectomy by three-dimensional imaging using multidetector-row CT for laparoscopic gastrectomy. Abdom Imaging 2006;31:268-276.
  11. Matsuki M, Tanikake M, Kani H, Tatsugami F, Kanazawa S, Kanamoto T, et al. Dual-phase 3D CT angiography during a single breath-hold using 16-MDCT: assessment of vascular anatomy before laparoscopic gastrectomy. AJR Am J Roentgenol 2006;186:1079-1085.
  12. Ferrari R, De Cecco CN, Iafrate F, Paolantonio P, Rengo M, Laghi A. Anatomical variations of the coeliac trunk and the mesenteric arteries evaluated with 64-row CT angiography. Radiol Med (Torino) 2007;112:988-998.
  13. Lebre MA, Vacavant A, Grand-Brochier M, Rositi H, Abergel A, Chabrot P, et al. Automatic segmentation methods for liver and hepatic vessels from CT and MRI volumes, applied to the Couinaud scheme. Comput Biol Med 2019;110:42-51.
  14. Sunagawa H, Kinoshita T. Three-dimensional computed tomography simulation for laparoscopic lymph node dissection in the treatment of proximal gastric cancer. Transl Gastroenterol Hepatol 2017;2:54.
  15. Zhu C, Kong SH, Kim TH, Park SH, Ang RR, Diana M, et al. The anatomical configuration of the splenic artery influences suprapancreatic lymph node dissection in laparoscopic gastrectomy: analysis using a 3D volume rendering program. Surg Endosc 2018;32:3697-3705.
  16. Ri M, Ohashi M, Makuuchi R, Hayami M, Sano T, Nunobe S. Clinical impact of polyglycolic acid mesh to reduce pancreas-related complications after minimally invasive surgery for gastric cancer: a propensity score matching analysis. J Gastric Cancer 2024;24:220-230.
  17. Ushiku H, Sakuraya M, Washio M, Hosoda K, Niihara M, Harada H, et al. Pancreas-contactless gastrectomy for gastric cancer prevents postoperative inflammation. Surg Endosc 2022;36:5644-5651.
  18. Obama K, Okabe H, Hosogi H, Tanaka E, Itami A, Sakai Y. Feasibility of laparoscopic gastrectomy with radical lymph node dissection for gastric cancer: from a viewpoint of pancreas-related complications. Surgery 2011;149:15-21.
  19. Ohi M, Toiyama Y, Yasuda H, Ichikawa T, Uratani R, Kitajima T, et al. Prediction of post-gastrectomy pancreatic complications: a preoperative imaging study based on computed tomography. Am Surg 2024;90:1552-1560.
  20. Migita K, Matsumoto S, Wakatsuki K, Ito M, Kunishige T, Nakade H, et al. The anatomical location of the pancreas is associated with the incidence of pancreatic fistula after laparoscopic gastrectomy. Surg Endosc 2016;30:5481-5489.
  21. Sugase T, Takahashi T, Takiguchi S, Kurokawa Y, Teranishi R, Saito T, et al. Pancreas-left gastric artery angle is associated with postoperative inflammation and drain amylase after laparoscopic gastrectomy. Asian J Endosc Surg 2021;14:756-766.