Spleen preservation versus splenectomy in laparoscopic total gastrectomy with D2 lymphadenectomy for gastric cancer: A comparison of short-term outcomes

Asian J Endosc Surg. 2016 Feb;9(1):5-13. doi: 10.1111/ases.12255. Epub 2015 Nov 9.

Abstract

Introduction: Splenic hilar lymph node dissection via a splenectomy for advanced proximal gastric cancer remains controversial. Recently, a laparoscopic spleen-preserving hilar lymph node dissection procedure was described in several publications. To assess the feasibility and safety of spleen-preserving laparoscopic total gastrectomy with D2 lymphadenectomy (LTG-D2), the present retrospective study compared the short-term surgical outcomes between spleen preservation and splenectomy during laparoscopic D2 total gastrectomy (LTG-D2S).

Method: This study included 59 patients who underwent LTG-D2 and 19 patients who underwent LTG-D2S.

Results: The mean operation time did not significantly differ between the LTG-D2 and LTG-D2S groups (339.4 ± 56.8 vs 356.8 ± 46.0 min). The mean blood loss tended to be smaller in the LTG-D2 group than in the LTG-D2S group (105.9 ± 89.7 vs 210.0 ± 149.5 mL). The mean number of retrieved lymph nodes did not significantly differ between the LTG-D2 and LTG-D2S groups (39.9 ± 17.0 vs 40.6 ± 14.9), and the mean number of retrieved lymph nodes at the splenic hilum also did not significantly differ between the LTG-D2 and LTG-D2S groups (1.3 ± 1.7 vs 2.4 ± 2.6). Mild pancreatic fistula occurred in three cases (5%) in the LTG-D2 group and in three cases (15.8%) in the LTG-D2S group.

Conclusion: A LTG-D2 is feasible in terms of the short-term outcomes. However, the indications for this complicated procedure should be considered carefully.

Keywords: Advanced gastric cancer; laparoscopic total gastrectomy; spleen preservation.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Anastomosis, Roux-en-Y
  • Female
  • Gastrectomy / methods*
  • Humans
  • Laparoscopy / methods*
  • Lymph Node Excision*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Retrospective Studies
  • Splenectomy*
  • Stomach Neoplasms / pathology*
  • Stomach Neoplasms / surgery*
  • Treatment Outcome