Laparoscopic Surgery for Gastric Cancer, Total Gastrectomy with D2 Lymph Node Dissection

  • Yoo Min Kim
  • Woo Jin HyungEmail author


For advanced gastric cancer located in the upper body of the stomach, total gastrectomy with D2 lymph node dissection is recommended [1–4]. D2 lymph node dissection for proximal tumors requires the retrieval of the soft tissues around distal portions of the splenic vessels and splenic hilum, which contain lymph nodes at stations #10 and #11d [4, 5]. Two options – a total gastrectomy with splenectomy and a spleen-preserving total gastrectomy – exist for retrieval of lymph nodes at station #10. While splenectomy-related postoperative complications, such as subphrenic abscess and postsplenectomy syndrome, are well known, complete lymph node dissection of the splenic hilum during spleen-preserving total gastrectomy is a very complex procedure.



This work was not supported by external or grant funding. None of the authors have commercial associations or financial involvement that pose a conflict of interest in connection with the submitted article.

Supplementary material

(WMV 714954 kb)


  1. 1.
    Degiuli M, Sasako M, Ponti A, et al. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. Br J Surg. 2014;101:23–31.CrossRefGoogle Scholar
  2. 2.
    Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.CrossRefGoogle Scholar
  3. 3.
    Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359:453–62.CrossRefGoogle Scholar
  4. 4.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.CrossRefGoogle Scholar
  5. 5.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.CrossRefGoogle Scholar
  6. 6.
    Katai H, Yoshimura K, Fukagawa T, Sano T, Sasako M. Risk factors for pancreas-related abscess after total gastrectomy. Gastric Cancer. 2005;8(3):137–41.CrossRefGoogle Scholar
  7. 7.
    Yoshino K, Yamada Y, Asanuma F, Aizawa K. Splenectomy in cancer gastrectomy: recommendation of spleen-preserving for early stages. Int Surg. 1997;82(2):150–4.PubMedGoogle Scholar
  8. 8.
    Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H, Okajima K. Pancreas-preserving total gastrectomy for proximal gastric cancer. World J Surg. 1995;19(4):532–6.CrossRefGoogle Scholar
  9. 9.
    Aikou T, Shimazu H, Takao T, et al. Significance of lymph nodal metastases in treatment of esophagogastric adenocarcinoma. Lymphology. 1992;25:31–6.PubMedGoogle Scholar
  10. 10.
    Maruyama K, Gunven P, Okabayashi K, et al. Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg. 1989;210:596–602.CrossRefGoogle Scholar
  11. 11.
    Mönig SP, Collet PH, Baldus SE, Schmackpfeffer K, Schröder W, Thiele J, Dienes HP, Hölscher AH. Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol. 2001;76(2):89–92.CrossRefGoogle Scholar
  12. 12.
    Ikeguchi M, Kaibara N. Lymph node metastasis at the splenic hilum in proximal gastric cancer. Am Surg. 2004;70(7):645–8.PubMedGoogle Scholar
  13. 13.
    Hyung WJ, Lim JS, 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(2):e6–11.CrossRefGoogle Scholar
  14. 14.
    Shinohara T, Kanaya S, Taniguchi K, et al. Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg. 2009;144:1138–42.CrossRefGoogle Scholar
  15. 15.
    Jia-Bin W, Chang-Ming H, Chao-Hui Z, Ping L, Jian-Wei X, Jian-Xian L. Laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer in left approach: a new operation procedure. World J Surg Oncol. 2012;10:241.CrossRefGoogle Scholar
  16. 16.
    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. 2010;211:e1–6.CrossRefGoogle Scholar
  17. 17.
    Woo Y, Hyung WJ, Kim HI, Obama K, Son T, Noh SH. Minimizing hepatic trauma with a novel liver retraction method: a simple liver suspension using gauze suture. Surg Endosc. 2011;25(12):3939–45. Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery, CHA Bundang Medical CenterCHA UniversityGyeonggi-doRepublic of Korea
  2. 2.Department of SurgeryYonsei University College of MedicineSeoulRepublic of Korea

Personalised recommendations