Value Of Pancreatic Fascia Excision During D2 Radical Gastrectomy For Advanced Gastric Cancer

Abstract

Objective: To estimate the technical feasibility, safety, and oncological benefits of routine pancreatic fascia excision during D2 radical gastrectomy for advanced gastric tumor.

Patients and Methods: This prospective observational research involved 120 consecutive cases diagnosed with advanced gastric adenocarcinoma (T2-T4) who underwent D2 radical gastrectomy between January 2023 & December 2024. Cases have been allocated into two groups based on the surgeon's intraoperative decision and feasibility: a pancreatic fascia excision (PFE) group (n=60) and a Standard D2 (SD2) group (n=60). Primary outcomes included the yield of lymph nodes, particularly station 13 (peripancreatic), and R0 resection rates. Secondary outcomes assessed were postoperative complications (specifically pancreatic fistula, bleeding, and overall morbidity), operative time, estimated blood loss, and short-term locoregional recurrence patterns (within 12 months).

Results: The PFE group demonstrated a significantly higher yield of total harvested lymph nodes (p<0.001) and specifically station 13 lymph nodes (p<0.001). R0 resection rates were comparable between the PFE (95%) and SD2 (93.3%) groups (p=0.74). The incidence of clinically relevant pancreatic fistula (Grade B/C) was slightly higher in the PFE group (8.3% vs. 3.3% in SD2 group, p=0.25), though not statistically significant and generally manageable. Short-term peripancreatic nodal recurrence was lower in the PFE group (3.3% vs. 10% in SD2 group, p=0.10), suggesting a trend towards improved regional control.

Conclusion: Routine pancreatic fascia excision during D2 radical gastrectomy for advanced gastric tumor is technically feasible and leads to a significantly higher yield of peripancreatic lymph nodes, without a statistically significant increase in severe postoperative morbidity.