Surgical technique of vagus nerve-preserving gastrectomy with D2 lymphadenectomy for gastric cancer

Preservation of the vagus nerve in curative gastrectomy for gastric cancer is important to maintain postoperative quality of life. We developed a vagus nerve-preserving gastrectomy with D2 dissection for patients with early gastric cancer and for selected patients with T2 cancer. Following lymph node dissection along the left gastric artery, the root of the left gastric artery was isolated and divided. The coeliac branch was followed retrogradely, and the posterior gastric branches were cut at their origins. The hepatic branch was also preserved. A total of 136 patients, including 27 cases of T2 cancer, underwent the vagus nerve-preserving gastric operation, and surgical anatomy of the coeliac branch was studied. In 110 cases, variations in the course of the coeliac branch were classified into three types according to its relationship with the left gastric artery: close to the artery (43 cases, 39.1%), intermediate (47 cases, 42.7%) and away from the artery (20 cases, 18.2%). In 115 patients who underwent vagus nerve-preserving distal gastrectomy (n = 93) or pylorus-preserving gastrectomy (n = 22), the postoperative bodyweight was 95.6 +/- 5.2% of the preoperative bodyweight, and the incidence of gallstone formation was 1.8% (2 of 113). A D2 dissection comparable with conventional D2 gastrectomy could be carried out using the vagus nerve-preserving technique. The coeliac branch could be preserved regardless of its anatomy, resulting in improvements in postoperative quality of life.