Safety and feasibility of laparoscopic spleen-preserving No. 10 lymph node dissection for locally advanced upper third g
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Safety and feasibility of laparoscopic spleen‑preserving No. 10 lymph node dissection for locally advanced upper third gastric cancer: a prospective, multicenter clinical trial Chao‑Hui Zheng1 · Yan‑Chang Xu2 · Gang Zhao3 · Li‑Sheng Cai4 · Guo‑Xin Li5 · Ze‑Kuan Xu6 · Su Yan7 · Zu‑Guang Wu8 · Fang‑Qin Xue9 · Yi‑Hong Sun10 · Dong‑Bo Xu11 · Wen‑Bin Zhang12 · Jin‑Wan13 · Pei‑Wu Yu14 · Jian‑Kun Hu15 · Xiang‑Qian Su16 · Jia‑Fu Ji16 · Zi‑Yu Li16 · Jun You17 · Yong Li18 · Lin‑Fan19 · Jun‑Lu1 · Ping‑Li1 · Chang‑Ming Huang1 · for the Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group Received: 7 June 2019 / Accepted: 28 November 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background Previous retrospective studies have shown that laparoscopic spleen-preserving D2 total gastrectomy (LSTG) for advanced upper third gastric cancer (AUTGC) is safe. However, all previous studies were underpowered. We therefore conducted a prospective, multicenter study to evaluate the technical safety and feasibility of LSTG for patients with AUTGC. Methods Patients diagnosed with AUTGC (cT2-4a, N−/+, M0) underwent LSTG at 19 institutions between September 2016 and October 2017 were included. The number of No. 10 lymph node (LN) dissections, metastasis rates, intraoperative and postoperative complications were investigated. Results A total of 251 patients were enrolled in the study, and 242 patients were eligible for the per protocol analysis. The average numbers of No. 10 LN dissections and metastases were 2.4 and 0.1, respectively. Eighteen patients (7.4%) had No. 10 LN metastases, and among patients with advanced gastric cancer, the rate of No. 10 LN metastasis was 8.1% (18/223). pN3 status was an independent risk factor for No. 10 LN metastasis. Intraoperative complications occurred in 7 patients, but no patients required conversion to open surgery or splenectomy. The overall postoperative complication rate was 13.6% (33/242). The major complication and mortality rates were 3.3% (8/242) and 0.4% (1/242), respectively. The number of retrieved No. 10 LNs, No. 10 LN metastasis and TNM stage had no significant influence on postoperative complication rates. Conclusion LSTG for AUTGC was safe and effective when performed by very experienced surgeons, this technique could be used in patients who needed splenic hilar lymph node dissection. Keywords Gastric cancer · Prospective multicenter feasibility study · Laparoscopy · Spleen-preserving total gastrectomy Gastric cancer is the fifth most common malignancy and the third leading cause of cancer-related death worldwide [1]. In recent years, although the incidence of gastric cancer has remained steady, there has been a gradual increase in the number of patients with proximal gastric cancer [2, 3]; Chao-Hui Zheng, Yan-Chang Xu, Gang Zhao, Li-Sheng Cai, GuoXin Li have contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-019-0
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