Abstract
BackgroundLaparoscopic spleen-preserving Splenic hilar lymphadenectomy (LSPL) is required in laparoscopy-assisted total gastrectomy for advanced proximal gastric cancer. However, it is considerably difficult and risk in clinical practice. Thus, we explore the application of LSPL performed by following the perigastric fascias and the intrafascial space in D2 radical gastrectomy for advanced upper-third gastric cancer.MethodsFrom July 2010 to December 2012, 109 patients with T2–3 upper-third gastric cancer underwent LSPL. Of these patients, 55 underwent classic LSPL (classic group), and the remaining 54 patients underwent LSPL performed by following the fascias and intrafascial space (fascia group). Clinicopathologic characteristics and intraoperative and postoperative variables were compared between the two groups.ResultsThere were no significant differences in clinicopathological characteristics between the two groups (P>0.05). All of the operations were successful without conversion to laparotomy. The operation time, mean splenic hilar lymph node (LN) dissection time, mean total blood loss and mean blood loss from splenic hilar LN dissection were significantly lower in the fascia group than in the classic group (P<0.05), whereas the times to first flatus, fluid diet and soft diet and the duration of hospital stay were similar in both groups. The mean number of harvested LNs (No. 10 and No. 11d) was slightly higher in the fascia group, but the difference was not significant. No significant difference in morbidity was found between the fascia group and the classic group (9.3% vs.10.9%, P>0.05). At a median follow-up of 12 months(range 5 to 35 months), none of the patients had died or experienced recurrent or metastatic disease.ConclusionLSPL performed by following the fascias and intrafascial space is an optimal and safe technique based on anatomical logic, and it reduces the difficulties associated with LSPL, making it easier to master and allowing its widespread adoption.
Highlights
The lymph nodes (LNs) in the splenic hilar area, including LNs along the distal splenic vessels (No 11d) and the splenic hilum (No 10), should be removed for a normative D2 LN dissection during total gastrectomy for advanced upper gastric cancer [1]
Pancreatosplenectomy has been advocated for the complete removal of LNs in the splenic hilar area [2,3], it is only performed in cases with direct tumor extension to the distal pancreas and spleen or with definite LN metastasis at the splenic hilum due to the high incidence of associated postoperative complications and mortality [4]
The surgeon can fully free the tail of the pancreas and the spleen through mobilization of the spleen in vivo to thoroughly dissect the LNs in the splenic hilar area; the same method cannot be used during laparoscopic operations
Summary
The lymph nodes (LNs) in the splenic hilar area, including LNs along the distal splenic vessels (No 11d) and the splenic hilum (No 10), should be removed for a normative D2 LN dissection during total gastrectomy for advanced upper gastric cancer [1]. The surgeon can fully free the tail of the pancreas and the spleen through mobilization of the spleen in vivo to thoroughly dissect the LNs in the splenic hilar area; the same method cannot be used during laparoscopic operations. Laparoscopic spleen-preserving Splenic hilar lymphadenectomy (LSPL) is required in laparoscopy-assisted total gastrectomy for advanced proximal gastric cancer. It is considerably difficult and risk in clinical practice. We explore the application of LSPL performed by following the perigastric fascias and the intrafascial space in D2 radical gastrectomy for advanced upper-third gastric cancer
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