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Laparoscopic Spleen-Preserving No. 10 Lymph Node Dissection for Advanced Proximal Gastric Cancer Using a Left Approach

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Abstract

Background

We developed a novel procedure for spleen-preserving No. 10 lymph node (LN) dissection, which is difficult and advocates for patients with advanced proximal gastric cancer, except those with direct tumor extension to the spleen or definite LN metastasis at the splenic hilum.

Methods

The surgeon reveals the splenic vessels (SVs), and the assistant pulls up the lymphatic fatty tissue on the surface of the lower lobar vessels of the spleen (LLVSs). The surgeon then exposes the left gastroepiploic vessels (LGEVs), completely separating the LLVSs from the LGEV roots. After tracking the SV termini, the No. 11d LNs are carefully dissected and the upper lobar vessels of the spleen are exposed from their roots to the upper pole of the spleen. During this process, 2–4 branches of the short gastric vessels are skeletonized and divided at their roots. The LNs behind the SVs in front of Gerota’s fascia are then dissected. The above procedure was performed on 118 consecutive patients with stage cT2–3 disease.

Results

Mean operation time was 20.4 ± 6.0 min (range 13–41 min), mean blood loss was 13.6 ± 4.0 ml (range 10–40 ml), and mean times to first flatus, fluid diet, and soft diet were 3.3 ± 1.2 days (range 2–8 days), 4.8 ± 1.6 days (range 3–14 days), and 8.1 ± 4.1 days (range 6–20 days), respectively. A mean 44.6 ± 17.3 LNs (range 22–103) were retrieved, including a mean 3.0 ± 2.4 (range 0–11) splenic hilar area LNs. At a median follow-up of 9 months, no patients had died or experienced recurrent or metastatic disease.

Conclusions

This procedure is feasible and simplifies complicated laparoscopic No. 10 LN dissection.

References

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    Hyung WJ, Lim J-S, Song J, Choi SH, Noh SH. Laparoscopic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer. J Am Coll Surg. 2008;207:e6–11.

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    Okabe H, Obama K, Kan T, Tanaka E, Itami A, Sakai Y. Medial approach for laparoscopic total gastrectomy with splenic lymph node dissection. J Am Coll Surg. 210;211:e1–6.

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    Sakuramoto S, Kikuchi S, Futawatari N, Katada N, Moriya H, Hirai K, et al. Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy. Surg Endosc. 2009;23:2416–23.

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Author information

Correspondence to Chang-Ming Huang MD.

Electronic supplementary material

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Supplementary material 1 (MPG 243384 kb)

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Huang, C., Chen, Q., Lin, J. et al. Laparoscopic Spleen-Preserving No. 10 Lymph Node Dissection for Advanced Proximal Gastric Cancer Using a Left Approach. Ann Surg Oncol 21, 2051 (2014). https://doi.org/10.1245/s10434-014-3492-1

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Keywords

  • Total Gastrectomy
  • Short Gastric Vessel
  • Splenic Hilum
  • Laparoscopic Total Gastrectomy
  • Splenic Vessel