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Totally laparoscopic spleen-preserving splenic hilum lymph nodes dissection in radical total gastrectomy: an omnibearing method

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Abstract

Objective

To investigate the feasibility and safety of laparoscopic spleen-preserving splenic hilum lymph nodes (LNs) dissection for advanced proximal gastric cancer using an omnibearing method.

Methods

Between August 2013 and December 2014, 16 patients with advanced proximal gastric cancer treated in Guangdong Province Hospital of Chinese Medicine, were enrolled and subsequently underwent laparoscopic radical total gastrectomy (TG) with spleen-preserving splenic hilum LNs dissection. During dissecting Nos. 10 and 11 LNs, we divided them into two parts, namely LNs anterosuperior and posterior to the splenic vessel. The clinicopathological characteristics, intraoperative outcomes and postoperative courses were retrospectively collected and analyzed in the study.

Results

Laparoscopic surgery was successfully completed in all 16 patients without conversion to open surgery, and no perioperative death occurred. The mean operating time was 328.75 ± 46.96 min, and the mean estimated blood loss was 135.63 ± 62.07 ml. One patient experienced intraoperative bleeding due to the splenic vein injury which was successfully handled with laparoscopic vessel suturing, and one postoperative pulmonary infection was recorded. The mean time to first flatus was 3.56 ± 1.03 days with a mean 9.63 ± 1.50 days of postoperative hospital stay. The mean number of retrieved LNs was 28.31 ± 5.99, in which LNs anterosuperior to splenic artery was 2.88 ± 2.66 and LNs posterior was 1.38 ± 1.75.

Conclusion

Laparoscopic TG with spleen-preserving splenic hilum LNs dissection using an omnibearing method for advanced proximal gastric cancer was safe and technically feasible in experienced hands. Further studies in terms of its clinical significance are needed.

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References

  1. Japanese Gastric Cancer A (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2):113–123

    Article  Google Scholar 

  2. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251(3):417–420

    Article  PubMed  Google Scholar 

  3. Son SY, Kim HH (2014) Minimally invasive surgery in gastric cancer. World J Gastroenterol 20(39):14132–14141

    Article  PubMed  PubMed Central  Google Scholar 

  4. Japanese Gastric Cancer A (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14(2):101–112

    Article  Google Scholar 

  5. Wang JB, Huang CM, Zheng CH, Li P, Xie JW, Lin JX (2012) Laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer in left approach: a new operation procedure. World J Surg Oncol 10:241

    Article  Google Scholar 

  6. Mou TY, Hu YF, Yu J, Liu H, Wang YN, Li GX (2013) Laparoscopic splenic hilum lymph node dissection for advanced proximal gastric cancer: a modified approach for pancreas- and spleen-preserving total gastrectomy. World J Gastroenterol 19(30):4992–4999

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lee JH, Ahn SH, Park DJ, Kim HH, Lee HJ, Yang HK (2012) Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer. World J Surg 36(10):2394–2399

    Article  PubMed  Google Scholar 

  8. Hyung WJ, Lim JS, Song J, Choi SH, Noh SH (2008) Laparoscopic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer. J Am Coll Surg 207(2):e6–e11

    Article  PubMed  Google Scholar 

  9. Sasada S, Ninomiya M, Nishizaki M, Harano M, Ojima Y, Mastukawa H, Aoki H, Shiozaki S, Ohno S, Takakura N (2009) Frequency of lymph node metastasis to the splenic hilus and effect of splenectomy in proximal gastric cancer. Anticancer Res 29(8):3347–3351

    PubMed  Google Scholar 

  10. Kitamura K, Nishida S, Ichikawa D, Taniquchi H, Haqiwara A, Yamaquchi T, Sawai K (1999) No survival benefit from combined pancreaticosplenectomy and total gastrectomy for gastric cancer. Br J Surg 86(1):119–122

    Article  CAS  PubMed  Google Scholar 

  11. Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H, Okajima K (1995) Pancreas-preserving total gastrectomy for proximal gastric cancer. World J Surg 19(4):532–536

    Article  CAS  PubMed  Google Scholar 

  12. Doglietto GB, Pacelli F, Caprino P, Bossola M, Di Stasi C (2000) Pancreas-preserving total gastrectomy for gastric cancer. Arch Surg 135(1):89–94

    Article  CAS  PubMed  Google Scholar 

  13. Brady MS, Rogatko A, Dent LL, Shiu MH (1991) Effect of splenectomy on morbidity and survival following curative gastrectomy for carcinoma. Arch Surg 126(3):359–364

    Article  CAS  PubMed  Google Scholar 

  14. Adachi Y, Kamakura T, Mori M, Maehara Y, Sugimachi K (1994) Role of lymph node dissection and splenectomy in node-positive gastric carcinoma. Surgery 116(5):837–841

    CAS  PubMed  Google Scholar 

  15. Okajima K, Isozaki H (1995) Splenectomy for treatment of gastric cancer: Japanese experience. World J Surg 19(4):537–540

    Article  CAS  PubMed  Google Scholar 

  16. Lee KY, Noh SH, Hyung WJ, Lee JH, Lah KH, Choi SH, Min JS (2001) Impact of splenectomy for lymph node dissection on long-term surgical outcome in gastric cancer. Ann Surgical Oncol 8(5):402–406

    Article  Google Scholar 

  17. Weitz J, Jaques DP, Brennan M, Karpeh M (2004) Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer. Ann Surg Oncol 11(7):682–689

    Article  PubMed  Google Scholar 

  18. Vinuela EF, Gonen M, Brennan MF, Coit DG, Strong VE (2012) Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 255(3):446–456

    Article  PubMed  Google Scholar 

  19. Nakamura K, Katai H, Mizusawa J, Yoshikawa T, Ando M, Terashima M, Ito S, Takaqi M, Takaqane A, Ninomiya M, Fukushima N, Sasako M (2013) A phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer (JCOG0912). Jpn J Clin Oncol 43(3):324–327

    Article  PubMed  Google Scholar 

  20. Nam BH, Kim YW, Reim D, Eom BW, Yu WS, Park YK, Ryu KW, Lee YJ, Yoon HM, Lee JH, Jeong O, Jeong SH, Lee SE, Lee SH, Yoon KY, Seo KW, Chung HY, Kwon OK, Kim TB, Lee WK, Park SH, Sul JY, Yang DH, Lee JS (2013) Laparoscopy assisted versus open distal gastrectomy with D2 lymph node dissection for advanced gastric cancer: design and rationale of a phase ii randomized controlled multicenter trial (COACT 1001). J Gastric Cancer 13(3):164–171

    Article  PubMed  PubMed Central  Google Scholar 

  21. Moisan F, Norero E, Slako M, Varas J, Palominos G, Crovari F, Ibañez L, Pérez G, Pimentel F, Guzmán S, Jarufe N, Boza C, Escalona A, Funke R (2012) Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study. Surg Endosc 26(3):661–672

    Article  PubMed  Google Scholar 

  22. Chen K, Xu XW, Mou YP, Pan Y, Zhou YC, Zhang RC, Wu D (2013) Systematic review and meta-analysis of laparoscopic and open gastrectomy for advanced gastric cancer. World J Surg Oncol 11:182

    Article  PubMed  PubMed Central  Google Scholar 

  23. Jeong O, Jung MR, Kim GY, Kim HS, Ryu SY, Park YK (2013) Comparison of short-term surgical outcomes between laparoscopic and open total gastrectomy for gastric carcinoma: case–control study using propensity score matching method. J Am Coll Surg 216(2):184–191

    Article  PubMed  Google Scholar 

  24. Guan G, Jiang W, Chen Z, Liu X, Lu H, Zhang X (2013) Early results of a modified splenic hilar lymphadenectomy in laparoscopy-assisted total gastrectomy for gastric cancer with stage cT1-2: a case–control study. Surg Endosc 27(6):1923–1931

    Article  PubMed  Google Scholar 

  25. Bo T, Peiwu Y, Feng Q, Yongliang Z, Yan S, Yingxue H, Huaxing L (2013) Laparoscopy-assisted vs. open total gastrectomy for advanced gastric cancer: long-term outcomes and technical aspects of a case–control study. J Gastrointest 17(7):1202–1208

    Article  CAS  Google Scholar 

  26. Pandey SK, Bhattacharya S, Mishra RN, Shukla VK (2004) Anatomical variations of the splenic artery and its clinical implications. Clin Anat 17(6):497–502

    Article  CAS  PubMed  Google Scholar 

  27. Yu W, Choi GS, Chung HY (2006) Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 93(5):559–563

    Article  CAS  PubMed  Google Scholar 

  28. Monig SP, Collet PH, Baldus SE, Schmackpfeffer K, Schröder W, Thiele J, Dienes HP, Hölscher AH (2001) Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol 76(2):89–92

    Article  CAS  PubMed  Google Scholar 

  29. Maruyama K, Gunven P, Okabayashi K, Sasako M, Kinoshita T (1989) Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg 210(5):596–602

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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    Authors and Affiliations

    1. Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China

      Wei Wang, Zhiwei Liu, Wenjun Xiong, Yansheng Zheng, Lijie Luo, Dechang Diao & Jin Wan

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    1. Wei Wang
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    2. Zhiwei Liu
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    3. Wenjun Xiong
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    4. Yansheng Zheng
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    7. Jin Wan
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    Correspondence to Wenjun Xiong or Jin Wan.

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    Wei Wang, Zhiwei Liu, Wenjun Xiong, Yansheng Zheng, Lijie Luo, Dechang Diao and Jin Wan have no conflicts of interest or financial ties to disclose.

    Additional information

    Wei Wang and Zhiwei Liu contributed equally to this work in the design of the study and preparation of the manuscript and should be both considered as co-first authors. Wenjun Xiong and Jin Wan contributed equally to this work in the technique design, materials collection, analysis, interpretation of data and revising the article, they should be the co-correspondence authors.

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    Wang, W., Liu, Z., Xiong, W. et al. Totally laparoscopic spleen-preserving splenic hilum lymph nodes dissection in radical total gastrectomy: an omnibearing method. Surg Endosc 30, 2030–2035 (2016). https://doi.org/10.1007/s00464-015-4438-9

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