Published online Aug 14, 2013. doi: 10.3748/wjg.v19.i30.4992
Revised: May 31, 2013
Accepted: June 18, 2013
Published online: August 14, 2013
AIM: To investigate the feasibility and optimal approach for laparoscopic pancreas- and spleen-preserving splenic hilum lymph node dissection in advanced proximal gastric cancer.
METHODS: Between August 2009 and August 2012, 12 patients with advanced proximal gastric cancer treated in Nanfang Hospital, Southern Medical University, Guangzhou, China were enrolled and subsequently underwent laparoscopic total gastrectomy with pancreas- and spleen-preserving splenic hilum lymph node (LN) dissection. The clinicopathological characteristics, surgical outcomes, postoperative course and follow-up data of these patients were retrospectively collected and analyzed in the study.
RESULTS: Based on our anatomical understanding of peripancreatic structures, we combined the characteristics of laparoscopic surgery and developed a modified approach (combined supra- and infra-pancreatic approaches) for laparoscopic pancreas- and spleen-preserving splenic hilum LN dissection. Surgery was completed in all 12 patients laparoscopically without conversion. Only one patient experienced intraoperative bleeding when dissecting LNs along the splenic artery and was handled with laparoscopic hemostasis. The mean operating time was 268.4 min and mean number of retrieved splenic hilum LNs was 4.8. One patient had splenic hilum LN metastasis (8.3%). Neither postoperative morbidity nor mortality was observed. Peritoneal metastasis occurred in one patient and none of the other patients died or experienced recurrent disease during the follow-up period.
CONCLUSION: Laparoscopic total gastrectomy with pancreas- and spleen-preserving splenic hilum LN dissection using the modified approach for advanced proximal gastric cancer could be safely achieved.
Core tip: Pancreas- and spleen-preserving splenic hilum lymph node dissection in laparoscopic total gastrectomy is challenging. Even though a small number of skilled laparoscopic surgeons have demonstrated the safety and feasibility of this procedure, most surgeons adopt only the suprapancreatic approach. However, exposure and dissection of splenic hilum lymph nodes posterior to the splenic artery, especially its inferior branch is sometimes difficult and unpredicted injury or bleeding is more likely to occur if only through the suprapancreatic approach. We combined the supra- and infra-pancreatic approaches to better expose the posterior splenic artery lymph nodes at the splenic hilum and dissect more safely.