To explore the application value of prior esophageal trisection with mesenteric boundary-oriented radical gastrectomy in laparoscopic total gastrectomy for gastric cancer, and to improve the quality of radical resection and operational efficiency through optimizing the surgical procedure.

The clinical data of 28 gastric cancer patients admitted to Henan Cancer Hospital from Feb. 2024 to Dec. 2024 were retrospectively analyzed. All patients underwent the surgical procedure of "trisecting the esophagus first and then performing total gastric mesenteric boundary resection" , which involved freeing and trisecting the esophagus after laparoscopic exploration, and then accurately defining the anatomical boundaries of the left/gastric posterior mesentery, right gastric mesentery, right gastroepiploic mesentery, and left gastroepiploic/short gastric mesentery to complete total mesenteric resection. The indicators observed included intraoperative time under laparoscopy, intraoperative blood loss, esophageal margin status, number of lymph nodes dissected, and incidence of postoperative complications.

All 28 patients successfully completed the surgery without conversion to open surgery. The intraoperative time under laparoscopy was 75.21±5.03 minutes, intraoperative blood loss was 85.14±28.92 ml, the number of lymph nodes dissected was 32.14±11.56, and the incidence of postoperative complications was 3.6%(1/28). The median follow-up period was 8.3 months, with no tumor recurrence or metastasis, and intraoperative frozen section of the esophageal margin confirmed negative in all patients.

Prior esophageal trisection with mesenteric boundary-oriented radical gastrectomy can achieve standardized surgical operation by early clarification of the esophageal margin and optimization of the mesenteric exposure path, improve surgical efficiency while ensuring radical resection, and is safe and feasible.