Analysis of the short- and long-term outcomes of membrane anatomy-guided laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection for treating advanced proximal gastric cancer

• Main Authors: Yanchang Xu, Zhixiong Li, Guofeng Pan, Haiyan Wu, Wenlin Lin, Jian Chen, Junpeng Li
• Format: Article
• Language: English
• Published: BMC 2019-04-01
• Series: World Journal of Surgical Oncology
• Subjects: Mesenteric anatomy; Laparoscopy; Advanced proximal gastric adenocarcinoma; D2 lymph node dissection; Splenic hilar lymph node circumferential dissection
• Online Access: http://link.springer.com/article/10.1186/s12957-019-1610-z

Abstract Objective To investigate the short- and long-term efficacy of membrane anatomy-guided laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection for the treatment of advanced proximal gastric cancer. Methods A retrospective analysis was conducted in 186 patients with advanced proximal gastric cancer who underwent mesenteric anatomy-guided laparoscopic spleen-preserving splenic hilar lymph node dissection for advanced proximal gastric cancer in our center from March 2013 to March 2018. The patients were divided into two groups: one group was the laparoscopic anterior splenic hilar lymph node dissection group which we named L-ASHD, n = 103), while the other group was the laparoscopic circumferential splenic hilar lymph node dissection group which we named L-CSHD, n = 83). Results There was no significant difference in total operative time, intraoperative blood loss, postoperative length of hospital stay, and incidence of postoperative complications, etc. (P > 0.05). The number of harvested splenic hilar lymph nodes and the number of patients with harvested positive splenic hilar lymph nodes were both higher in the L-CSHD than in the L-ASHD (3.90 ± 2.52 vs. 3.02 ± 3.07, P < 0.05; 19 vs. 9 patients, P < 0.05). The positive rate of lymph nodes behind the splenic hilar was 8.4%. Kaplan–Meier survival curves showed that patients in the L-CSHD had similar OS and DFS compared with those of patients in the L-ASHD. Conclusion Membrane anatomy-guided laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection for advanced proximal gastric cancer is safe and feasible and can help avoid the incomplete dissection of positive lymph nodes.