Laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer in left approach: a new
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WORLD JOURNAL OF SURGICAL ONCOLOGY
TECHNICAL INNOVATIONS
Open Access
Laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer in left approach: a new operation procedure Wang Jia-Bin, Huang Chang-Ming*, Zheng Chao-Hui, Li Ping, Xie Jian-Wei and Lin Jian-Xian
Abstract Background: To explore the feasibility of laparoscopic spleen-preserving No. 10 lymph node dissection in a left-sided approach for advanced proximal gastric cancer. Methods: The clinical data of 32 patients with advanced proximal gastric cancer who underwent laparoscopic spleen-preserving No. 10 lymph node dissection from June 2010 to December 2011 were analyzed. Results: Laparoscopic spleen-preserving No. 10 lymph node dissection using a left-sided approach was successfully performed for all patients without open conversion. The mean operation time was 206.4±54.3 minutes, mean intraoperative blood loss was 68.2±34.1 ml, mean number of No. 10 lymph nodes dissected was 2.8±2.1, mean number of positive No. 10 lymph nodes was 0.6±1.2, and the incidence of No. 10 lymph node metastasis was 11.6%. The mean postoperative hospital stay was 11.3±1.5 days. The postoperative morbidity rate was 9.4%, and there was no postoperative death. Splenic lobar vessels of all 32 patients were anatomically classified and divided into three types: 4 patients had a single lobar vessel, 22 had two lobar vessels and 6 had three lobar vessels. Conclusions: Laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer using a left-sided approach is technically feasible. It simplifies the complicated surgical procedure of No. 10 lymph node dissection and leads to the popularization and promotion of this technique. Keywords: Stomach neoplasms, Spleen-preservation, Laparoscopy, Lymph node dissection
Background Many studies have reported that splenic hilar lymph nodes (No. 10 lymph nodes)metastasis in proximal gastric cancer is detected in 9.8% to 20.9% of cases [1,2]. When a surgeon undertakes total gastrectomy with D2 lymph node dissection for advanced proximal gastric cancer, he must dissect No. 10 lymph nodes [3]. In earlier years, the surgeon must undertake total gastrectomy with pancreaticosplenectomy in order to dissect the No. 10 and No. 11 lymph nodes [4]. However, because of the high rate of morbidity and mortality, this procedure had been usedfor gastric cancer which directly invaded the body and tail of the pancreas or spleen. At the same time, * Correspondence: [email protected] Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian Province, China
pancreas-preserving splenectomyusing No. 10 lymph node dissection had the same rate of postoperative survival and recurrence as pancreatosplenectomy, and had a lower rate of morbidity and mortality. It has gradually replaced pancreatosplenectomy in total gastrectomy with D2 lymph node dissection [5-8]. However, because of advances in surgical concepts, improvementsin the anatomical techniq
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