Analysis of the short- and long-term outcomes of membrane anatomy-guided laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection for treating advanced proximal gastric cancer

Yanchang Xu,Junpeng Li,Guofeng Pan,Haiyan Wu,Wenlin Lin,Jian Chen,Zhixiong Li

doi:10.1186/s12957-019-1610-z

Abstract

ObjectiveTo investigate the short- and long-term efficacy of membrane anatomy-guided laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection for the treatment of advanced proximal gastric cancer.MethodsA retrospective analysis was conducted in 186 patients with advanced proximal gastric cancer who underwent mesenteric anatomy-guided laparoscopic spleen-preserving splenic hilar lymph node dissection for advanced proximal gastric cancer in our center from March 2013 to March 2018. The patients were divided into two groups: one group was the laparoscopic anterior splenic hilar lymph node dissection group which we named L-ASHD, n = 103), while the other group was the laparoscopic circumferential splenic hilar lymph node dissection group which we named L-CSHD, n = 83).ResultsThere was no significant difference in total operative time, intraoperative blood loss, postoperative length of hospital stay, and incidence of postoperative complications, etc. (P > 0.05). The number of harvested splenic hilar lymph nodes and the number of patients with harvested positive splenic hilar lymph nodes were both higher in the L-CSHD than in the L-ASHD (3.90 ± 2.52 vs. 3.02 ± 3.07, P < 0.05; 19 vs. 9 patients, P < 0.05). The positive rate of lymph nodes behind the splenic hilar was 8.4%. Kaplan–Meier survival curves showed that patients in the L-CSHD had similar OS and DFS compared with those of patients in the L-ASHD.ConclusionMembrane anatomy-guided laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection for advanced proximal gastric cancer is safe and feasible and can help avoid the incomplete dissection of positive lymph nodes.

Highlights

There was no significant difference in total operative time, intraoperative blood loss, postoperative length of hospital stay, and incidence of postoperative complications, etc. (P > 0.05)
To ensure the thoroughness of splenic hilar lymph node dissection, we recently proposed for the first time the surgical concept of mesenteric anatomy-guided laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection and have applied it in our clinical practice
Comparison of perioperative data for the L-ASHD and the L-CSHD (Table 2) The results show that there were no significant differences in total operative time, intraoperative blood loss, postoperative anal exhaust time, postoperative time of starting fluid foods, postoperative length of hospital stay, or number of harvested positive lymph nodes in the two groups (P > 0.05)

Summary

Introduction

There was no significant difference in total operative time, intraoperative blood loss, postoperative length of hospital stay, and incidence of postoperative complications, etc. (P > 0.05). There was no significant difference in total operative time, intraoperative blood loss, postoperative length of hospital stay, and incidence of postoperative complications, etc. The number of harvested splenic hilar lymph nodes and the number of patients with harvested positive splenic hilar lymph nodes were both higher in the L-CSHD than in the L-ASHD (3.90 ± 2.52 vs 3.02 ± 3.07, P < 0.05; 19 vs 9 patients, P < 0.05). The positive rate of lymph nodes behind the splenic hilar was 8.4%. Kaplan–Meier survival curves showed that patients in the L-CSHD had similar OS and DFS compared with those of patients in the L-ASHD

Methods

Results

Discussion

Conclusion