Application of Huang's three-step maneuver for laparoscopic spleen-preserving splenic hilus lymphadenectomy for advanced proximal gastric cancer

Abstract

Objective To investigate the clinical efficacy of Huang's three-step maneuver in laparoscopic spleen-preserving splenic hilar (No. 10 lymph node) lymphadenectomy for advanced proximal gastric cancer. Methods The clinical data of 122 patients who underwent laparoscopic spleen-preserving No. 10 lymphadenectomy for advanced proximal gastric cancer by Huang's three-step maneuver at the Affiliated Union Hospital of Fujian Medical University from March 2013 to December 2013 were retrospectively analyzed. All the patients received laparoscopy-assisted radical total gastrectomy combined with spleen-preserving D2 lymph node dissection. The intraoperative and postoperative recoveries and complications of patients were analyzed. All patients were followed up by outpatient examination, visit, correspondence and telephone interview up to March 1, 2014. Results One patient received splenectomy due to intraoperative splenic artery injury and the other 121 patients received successfully laparoscopic spleen-preserving No. 10 lymphadenectomy. The operation time, volume of intraoperative blood loss, time and volume of blood loss in No. 10 lymphadenectomy were (175 ±27) minutes, (60 ±43) mL, (21 ± 8) minutes and (15 ±13 ) mL, respectively. The total and mean numbers of lymph node dissection in 122 patients were 4 797 and 44 ±18, respectively. The total and mean numbers of No. 10 lymph node dissection were 354 and 2.9 ± 2.4, respectively. Thirty-seven No. 10 lymph node metastases were detected in 15 patients, with a metastasis rate of 12.30% (15/ 122). The time to anal exsufflation, time for fluid diet intake, duration of hospital stay and incidence of complications were (4.0 ± 0.8) days, (4.9 ± 1.8) days, (12 ± 7) days and 11.48% (14/ 122) , respectively. All the 122 patients were followed up for a median time of 8 months (range, 2-12 months). No tumor recurrence, tumor metastasis and death were observed during follow-up. Conclusions Huang's three-step maneuver simplifies the complicated surgical procedures of laparoscopic spleen-preserving No. 10 lymphadenectomy for advanced proximal gastric cancer, its clinical efficacy is satisfactory with an advantage of clinical application. Key words: Gastric neoplasms; Laparoscopy; Splenic hilar; Lymph node dissection