Robotic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer

  • Kun Yang
  • Minah Cho
  • Chul Kyu Roh
  • Won Jun Seo
  • Seohee Choi
  • Taeil Son
  • Hyoung-Il Kim
  • Woo Jin HyungEmail author
Dynamic Manuscript



Robotic system may have potential advantages to facilitate the technically challenging splenic hilar lymphadenectomy during gastrectomy for gastric cancer. However, robotic spleen-preserving splenic hilar lymphadenectomy is performed infrequently not only because of the limited availability of the robot but also because of its technical difficulty. In this study, we describe our technique of performing robotic spleen-preserving splenic hilar lymphadenectomy in detail to facilitate wider application and present operative outcomes and the follow-up results of the procedure.


From 2005 to 2015, 93 patients underwent robotic total gastrectomy with D2 lymphadenectomy. One patient with obvious lymph node (LN) metastasis received splenectomy and was excluded from the analysis. Intraoperative complications, operation and console time, estimated blood loss, postoperative morbidity and mortality, the number of harvested LNs in total and at the splenic hilum, and 5-year overall survival were analyzed, retrospectively.


Among the 92 patients, robotic spleen-preserving splenic hilar lymphadenectomy was successfully performed in 91 patients except one who experienced intraoperative splenic artery injury which demanded splenectomy to be performed simultaneously. The overall mean operation time and console time were 287.2 ± 66.0 and 180.2 ± 47.2 min, respectively. Mean estimated blood loss was 141.1 ± 227.0 ml. The mortality was 1.1% (1/92). The overall postoperative morbidity rate was 16.3% (15/92). There was no case of pancreatic fistula, whole splenic infarction, or the delayed aneurysm of splenic artery. The mean numbers of harvested LNs in total and at the splenic hilum were 50.8 ± 18.1 and 1.9 ± 2.6. The 5-year overall survival was 86.3% and 5-year recurrence-free survival was 87.4%.


This study suggests that robotic application for spleen-preserving splenic hilar lymphadenectomy could be a feasible and safe method.


Gastric cancer Robot Total gastrectomy Spleen preservation Splenic hilar dissection D2 lymph node dissection 



This study was supported by a grant to Dr. Woo Jin Hyung from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (No. 1320270) and by grants to Dr. Kun Yang from the National Natural Science Foundation of China (No. 81772547) and the Sichuan University Scholarship Fund. We would like to thank Anthony Thomas Milliken, ELS (Editing Synthase, Seoul, Korea) for his assistance with editing the manuscript. We also acknowledge the assistance of BioScience Writers, LLC (Houston, TX, USA) with copyediting and correction of English language usage.

Compliance with ethical standards


Dr. Woo Jin Hyung is a consultant for Ethicon and Verb Surgical, and has stock in Hutom. Drs. Kun Yang, Minah Cho, Chul Kyu Roh, Won Jun Seo, Seohee Choi, Taeil Son, and Hyoung-Il Kim have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MP4 114611 kb)

Supplementary material 2 (MP4 125410 kb)

Supplementary material 3 (MP4 178901 kb)


  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108CrossRefGoogle Scholar
  2. 2.
    Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265(10):1287–1289CrossRefGoogle Scholar
  3. 3.
    Hasegawa S, Yoshikawa T (2010) Adenocarcinoma of the esophagogastric junction: incidence, characteristics, and treatment strategies. Gastric Cancer 13(2):63–73CrossRefGoogle Scholar
  4. 4.
    Liu K, Yang K, Zhang W, Chen X, Chen X, Zhang B, Chen Z, Chen J, Zhao Y, Zhou Z, Chen L, Hu J (2016) Changes of esophagogastric junctional adenocarcinoma and gastroesophageal reflux disease among surgical patients during 1988–2012: a single-institution. High-volume experience in China. Ann Surg 263(1):88–95CrossRefGoogle Scholar
  5. 5.
    Japanese gastric cancer association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2):113–123CrossRefGoogle Scholar
  6. 6.
    Yang K, Chen XZ, Hu JK, Zhang B, Chen ZX, Chen JP (2009) Effectiveness and safety of splenectomy for gastric carcinoma: a meta-analysis. World J Gastroenterol 15(42):5352–5359CrossRefGoogle Scholar
  7. 7.
    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):559–563CrossRefGoogle Scholar
  8. 8.
    Li C, Kim S, Lai JF, Oh SJ, Hyung WJ, Choi WH, Choi SH, Zhu ZG, Noh SH (2009) Lymph node dissection around the splenic artery and hilum in advanced middle third gastric carcinoma. Eur J Surg Oncol 35(7):709–714CrossRefGoogle Scholar
  9. 9.
    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):e6–11CrossRefGoogle Scholar
  10. 10.
    Huang CM, Chen QY, Lin JX, Zheng CH, Li P, Xie JW, Wang JB, Lu J (2014) Laparoscopic spleen-preserving splenic hilar lymphadenectomy performed by following the perigastric fascias and the intrafascial space for advanced upper-third gastric cancer. PLoS ONE 9(3):e90345CrossRefGoogle Scholar
  11. 11.
    Son T, Lee JH, Kim YM, Kim HI, Noh SH, Hyung WJ (2014) Robotic spleen-preserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surg Endosc 28(9):2606–2615CrossRefGoogle Scholar
  12. 12.
    Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH (2009) Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg 249(6):927–932CrossRefGoogle Scholar
  13. 13.
    Ballantyne GH (2007) Telerobotic gastrointestinal surgery: phase 2–safety and efficacy. Surg Endosc 21(7):1054–1062CrossRefGoogle Scholar
  14. 14.
    Woo Y, Hyung WJ, Kim HI, Obama K, Son T, Noh SH (2011) Minimizing hepatic trauma with a novel liver retraction method: a simple liver suspension using gauze suture. Surg Endosc 25(12):3939–3945CrossRefGoogle Scholar
  15. 15.
    Yang K, Bang HJ, Almadani ME, Dy-Abalajon DM, Kim YN, Roh KH, Lim SH, Son T, Kim HI, Noh SH, Hyung WJ (2016) Laparoscopic proximal gastrectomy with double-tract reconstruction by intracorporeal anastomosis with linear staplers. J Am Coll Surg 222(5):e39–45CrossRefGoogle Scholar
  16. 16.
    Lee HW, Kim HI, An JY, Cheong JH, Lee KY, Hyung WJ, Noh SH (2011) Intracorporeal anastomosis using linear stapler in laparoscopic distal gastrectomy: comparison between gastroduodenostomy and gastrojejunostomy. J Gastric Cancer 11(4):212–218CrossRefGoogle Scholar
  17. 17.
    Yang K, Zhang WH, Chen XZ, Chen XL, Zhang B, Chen ZX, Zhou ZG, Hu JK (2014) Survival benefit and safety of no. 10 lymphadenectomy for gastric cancer patients with total gastrectomy. Medicine 93(25):e158CrossRefGoogle Scholar
  18. 18.
    Yang K, Lu ZH, Zhang WH, Liu K, Chen XZ, Chen XL, Guo DJ, Zhou ZG, Hu JK (2015) Comparisons between different procedures of No 10 lymphadenectomy for gastric cancer patients with total gastrectomy. Medicine (Baltimore) 94(33):e1305CrossRefGoogle Scholar
  19. 19.
    Ishikawa S, Shimada S, Miyanari N, Hirota M, Takamori H, Baba H (2009) Pattern of lymph node involvement in proximal gastric cancer. World J Surg 33(8):1687–1692CrossRefGoogle Scholar
  20. 20.
    Kosuga T, Ichikawa D, Okamoto K, Komatsu S, Shiozaki A, Fujiwara H, Otsuji E (2011) Survival benefits from splenic hilar lymph node dissection by splenectomy in gastric cancer patients: relative comparison of the benefits in subgroups of patients. Gastric Cancer 14(2):172–177CrossRefGoogle Scholar
  21. 21.
    Hasegawa S, Yoshikawa T, Rino Y, Oshima T, Aoyama T, Hayashi T, Sato T, Yukawa N, Kameda Y, Sasaki T, Ono H, Tsuchida K, Cho H, Kunisaki C, Masuda M, Tsuburaya A (2013) Priority of lymph node dissection for Siewert type II/III adenocarcinoma of the esophagogastric junction. Ann Surg Oncol 20(13):4252–4259CrossRefGoogle Scholar
  22. 22.
    Sasako M, McCulloch P, Kinoshita T, Maruyama K (1995) New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg 82(3):346–351CrossRefGoogle Scholar
  23. 23.
    Park SS, Kim MC, Park MS, Hyung WJ (2012) Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons. Surg Endosc 26(1):60–67CrossRefGoogle Scholar
  24. 24.
    Kim HI, Han SU, Yang HK, Kim YW, Lee HJ, Ryu KW, Park JM, An JY, Kim MC, Park S, Song KY, Oh SJ, Kong SH, Suh BJ, Yang DH, Ha TK, Kim YN, Hyung WJ (2016) Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. Ann Surg 263(1):103–109CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Gastric Cancer Center, Yonsei Cancer CenterYonsei University Health SystemSeoulRepublic of Korea
  3. 3.Department of Gastrointestinal Surgery, West China HospitalSichuan UniversityChengduChina
  4. 4.State Key Laboratory of Biotherapy, Institute of Gastric Cancer, West China HospitalSichuan UniversityChengduChina

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