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Safety and feasibility of laparoscopic spleen-preserving No. 10 lymph node dissection for locally advanced upper third gastric cancer: a prospective, multicenter clinical trial

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Abstract

Background

Previous retrospective studies have shown that laparoscopic spleen-preserving D2 total gastrectomy (LSTG) for advanced upper third gastric cancer (AUTGC) is safe. However, all previous studies were underpowered. We therefore conducted a prospective, multicenter study to evaluate the technical safety and feasibility of LSTG for patients with AUTGC.

Methods

Patients diagnosed with AUTGC (cT2-4a, N−/+, M0) underwent LSTG at 19 institutions between September 2016 and October 2017 were included. The number of No. 10 lymph node (LN) dissections, metastasis rates, intraoperative and postoperative complications were investigated.

Results

A total of 251 patients were enrolled in the study, and 242 patients were eligible for the per protocol analysis. The average numbers of No. 10 LN dissections and metastases were 2.4 and 0.1, respectively. Eighteen patients (7.4%) had No. 10 LN metastases, and among patients with advanced gastric cancer, the rate of No. 10 LN metastasis was 8.1% (18/223). pN3 status was an independent risk factor for No. 10 LN metastasis. Intraoperative complications occurred in 7 patients, but no patients required conversion to open surgery or splenectomy. The overall postoperative complication rate was 13.6% (33/242). The major complication and mortality rates were 3.3% (8/242) and 0.4% (1/242), respectively. The number of retrieved No. 10 LNs, No. 10 LN metastasis and TNM stage had no significant influence on postoperative complication rates.

Conclusion

LSTG for AUTGC was safe and effective when performed by very experienced surgeons, this technique could be used in patients who needed splenic hilar lymph node dissection.

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Acknowledgements

The study was sponsored by the Scientific and technological innovation joint capital projects of Fujian Province (2016Y9031, 2017Y9011); Construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171); The second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013); Chinese physicians association young physician respiratory research fund of Fujian province medical innovation project (2015-CXB-16).

Funding

The study was sponsored by the Scientific and technological innovation joint capital projects of Fujian Province (2016Y9031, 2017Y9011); Construction Project of Fujian Province Minimally Invasive Medical Center (No.[2017]171); The second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013); Chinese physicians association young physician respiratory research fund of Fujian province medical innovation project (2015-CXB-16).

Author information

Author notes

  1. Chao-Hui Zheng, Yan-Chang Xu, Gang Zhao, Li-Sheng Cai, Guo-Xin Li have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China

    Chao-Hui Zheng,  Jun-Lu,  Ping-Li & Chang-Ming Huang

  2. Fujian Medicine University, Teaching Hospital, The First Hospital of PuTian City, Putian, 351100, China

    Yan-Chang Xu

  3. Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

    Gang Zhao

  4. Department of General Surgery Unit 4, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian, China

    Li-Sheng Cai

  5. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China

    Guo-Xin Li

  6. Department of General Surgery, Jiangsu Province Hospital, Nanjing Medical University, Nanjing, 210000, China

    Ze-Kuan Xu

  7. Department of Gastrointestinal Surgery, Affiliated Hospital of Qinghai University, Qinghai Medical University, Xining, 810000, China

    Su Yan

  8. Department of General Surgery Unit 2, Meizhou People’s Hospital of Guangdong, Meizhou, 514021, China

    Zu-Guang Wu

  9. Department of Gastrointestinal Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China

    Fang-Qin Xue

  10. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Yi-Hong Sun

  11. Department of General Surgery, Longyan First Hospital, Longyan, 364000, China

    Dong-Bo Xu

  12. Department of General Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Wulumuqi, 830001, China

    Wen-Bin Zhang

  13. Department of General Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510515, China

    Jin-Wan

  14. Department of General Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China

    Pei-Wu Yu

  15. Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Sichuan University, Chengdu, 610000, China

    Jian-Kun Hu

  16. Gastrointestinal Cancer Center, Beijing University Cancer Hospital, Beijing, 100142, China

    Xiang-Qian Su, Jia-Fu Ji & Zi-Yu Li

  17. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361000, China

    Jun You

  18. Department of Gastrointestinal Surgery, Guangdong General Hospital, Guangzhou, 510515, China

    Yong Li

  19. Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, China

    Lin-Fan

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  1. Chao-Hui Zheng
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for the Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group

Contributions

CMH, CHZ, and PL designed the study. JL, PL, CHZ, and CMH wrote the first draft of the manuscript. YCX, GZ, LSC, GXL, ZKX, SY, ZGW, FQX, YHS, DPX, WBZ, JW, PWY, JKH, XQS, JFJ, ZYL, JY, YL, and LF critically evaluated, improved the study design and manuscript, and shared the responsibility for the final manuscript and the decision to submit. All of the authors were responsible for data collection and evaluation and approval of the manuscript.

Corresponding author

Correspondence to Chang-Ming Huang.

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Disclosures

Drs. Chang-Ming Huang, Chao-Hui Zheng, Ping-Li, Jun-Lu, Yan-Chang Xu, Gang Zhao, Li-Sheng Cai, Guo-Xin Li, Ze-Kuan Xu, Su Yan, Zu-Guang Wu, Fang-Qin Xue, Yi-Hong Sun, Dong-Bo Xu, Wen-Bin Zhang, Jin-Wan, Pei-Wu Yu, Jian-Kun Hu, Xiang-Qian Su, Jia-Fu Ji, Zi-Yu Li, Jun You, Yong Li, and Lin-Fan have no conflicts of interest or financial ties to disclose.

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Supplementary material 1 (DOCX 24305 kb)

Supplementary material 2 Supplementary Fig. 1 Schematic diagram of the No. 10 lymph node after cleaning (TIFF 13481 kb)

Supplementary material 3 Supplementary Fig. 2 Number of total and No. 10 LNs dissected at each center (TIFF 2931 kb)

464_2019_7306_MOESM4_ESM.tiff

Supplementary material 4 Supplementary Fig. 3 Comparison with other studies about spleen-preserving total gastrectomy (TIFF 745 kb)

464_2019_7306_MOESM5_ESM.tif

Supplementary material 5 Supplementary Fig. 4 Using Chi square test to compare with other studies about spleen-preserving total gastrectomy (TIFF 1076 kb)

Supplementary material 6 (DOCX 17 kb)

Supplementary material 7 (DOCX 13 kb)

Supplementary material 8 (DOCX 18 kb)

Supplementary material 9 (DOCX 20 kb)

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Zheng, CH., Xu, YC., Zhao, G. et al. Safety and feasibility of laparoscopic spleen-preserving No. 10 lymph node dissection for locally advanced upper third gastric cancer: a prospective, multicenter clinical trial. Surg Endosc 34, 5062–5073 (2020). https://doi.org/10.1007/s00464-019-07306-8

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