D2 lymphadenectomy including No.10 lymph nodes (LNs) is the standard procedure for treating advanced gastric cancer (AGC) via total gastrectomy. However, there was no research focusing on the posterior LN dissection along the splenic vessels (No.10p LNs). This study is performed to assess the effect of dissecting No.10p LNs.
We analyzed 404 consecutive gastric cancer patients who underwent laparoscopic total gastrectomy (LTG) with D2 lymphadenectomy. There were 68 patients with No.10p LN dissection (No.10p group), and 336 patients without No.10p LN dissection (nNo.10p group). The surgical outcomes are compared.
No.10p LN dissection was preferentially performed in patients who were younger and had a lower BMI, concentrated and single-branched type of splenic artery, and pancreatic tail near the lower pole of the spleen. The time for No.10 LN dissection and the number of No.10 LNs were greater in the No.10p group than in the nNo.10p group. There was no No.10p LNs metastasis, and the numbers of positive No.10 LNs were similar between the two groups. The morbidity and mortality rates of the No.10p group were comparable to those of the nNo.10p group. The overall survival (OS) rates of the two groups were not significantly different (P > 0.05).
Although No.10p LN dissection might retrieve more No.10 LNs, operation times were longer, and the number of positive No.10 LNs and the OS rate were not improved. It might be no necessary to dissect No.10p LNs during total gastrectomy with D2 lymphadenectomy for AGC.
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- Japanese gastric cancer treatment guidelines 2014 (ver.4).Gastric cancer. 2017; 20: 1-19
- Role of splenectomy in gastric cancer surgery: adverse effect of elective splenectomy on long term survival.J Am Coll Surg. 1997; 185: 177-184
- Yonsei Gastric Cancer Clinic. The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer.J Surg Oncol. 2009; 99: 275-280
- Impact of splenectomy on circulating immunoglobulin levels and the development of postoperative infection following total gastrectomy for gastric cancer.Br J Surg. 1996; 83: 1776-1778
- Spleen-preserving splenic hilar lymphadenectomy at the time of gastrectomy for cancer: technical feasibility and early results.J Surg Oncol. 2002; 79: 73-76
- Spleen preservation in radical surgery for gastric cardia cancer.Ann Surg Oncol. 2007; 14: 1312-1319
- Current advances and changes in treatment strategy may improve survival and quality of life in patients with potentially curable gastric cancer.Ann Surg Oncol. 1999; 6: 46-56
- Laparoscopic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer.J Am Coll Surg. 2008; 207 (e6–11)
- Laparoscopic spleen-preserving splenic hilar lymph node dissection for proximal gastric cancer (in Chinese).Chin J Surg. 2011; : 795-798
- Laparoscopic spleen-preserving No.10 lymph node dissection for advanced proximal gastric cancer in left approach: a new operation procedure.World J Surg Oncol. 2012; 10: 241
- Laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer using a left approach.Ann Surg Oncol. 2014; 21: 2051
- Huang's three-step maneuver for laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer.Chin J Cancer Res. 2014; 26: 208-210
- The ASA classification of physical status-a recapitulation.Anesthesiology. 1978; 49: 233-236
- Role of 3DCT in laparoscopic total gastrectomy with spleen-preserving splenic lymph node dissection.World J Gastroenterol. 2014; 20: 4797-4805
- Development and implementation of a clinical data mining system for gastric cancer surgery (in Chinese).Chin J Gastrointest Surg. 2010; 13: 510-515
- Japanese classification of gastric carcinoma: 3rd English edition.Gastric Cancer. 2011; 14: 101-112
- International union against cancer (UICC) TNM classification of malignant tumours.7th ed. Wiley–Liss, New York2010
- Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer.J Clin Oncol. 2011; 29: 4387-4393
- CLASSIC trial investigators. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial.Lancet. 2012; 379: 315-321
- The splenic hilar vascular anatomy and the influence of splenic artery type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy for gastric cancer.World J Gastroenterol. 2015; 21: 8389-8397
- Strategies of laparoscopic spleen-preserving splenic hilar lymph node dissection for advanced proximal gastric cancer.World J Gastrointest Surg. 2016; 8: 402-406
- Proposed classification of complications of surgery with examples of utility in cholecystectomy.Surgery. 1992; 111: 518-526
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Global cancer statistics.CA Cancer J Clin. 2011; 61: 69-90
- Gastric cancer.Lancet. 2009; 374: 477-490
- Marked regional variation in adenocarcinomas of the esophagus and the gastric cardia in the United States.Cancer. 2002; 95: 2096-2102
- Randomized comparison of morbidity after D1 and D2 dissection for gastric cancer in 966 Dutch patients.Lancet. 1995; 345: 745-748
- Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial.Lancet Oncol. 2010; 11: 439-449
- A multicentric Western analysis of prognostic factors in advanced, node-negative gastric cancer patients.Ann Surg. 2010; 252: 70-73
- Stomach cancer study group of the Japan clinical oncology group. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma.Ann Surg. 2017; 265: 277-283
- Prospective analysis of the diagnostic yield of extended en bloc resection for adenocarcinoma of the oesophagus or gastric cardia.Br J Surg. 2001; 88: 715-719
- Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus.J Surg Oncol. 2001; 76: 89-92
- Surgical management of adenocarcinoma of the cardia.Am J Surg. 1998; 175: 418-421
- Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1002 consecutive patients.Ann Surg. 2000; 232: 353-361
- Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy.Surg Endosc. 2009; 23: 2416-2423
- A preoperatively predictive difficulty scoring system for laparoscopic spleen-preserving splenic hilar lymph node dissection for gastric cancer: experience from a large-scale single center.Surg Endosc. 2016; 30: 4092-4101
- Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database.J Clin Oncol. 2005; 23: 7114-7124
- Impact of spleen preservation in patients with gastric cancer.Anticancer Res. 2005; 25: 3023-3030
- Medial approach for laparoscopic total gastrectomy with splenic lymph node dissection.J Am Coll Surg. 2010; 211 (e1–6)
- Clinical significance of splenic hilar lymph node metastasis in proximal gastric cancer.Ann Surg Oncol. 2009; 16: 1304-1309
- Effect of splenectomy on morbidity and survival following curative gastrectomy for carcinoma.Arch Surg. 1991; 126: 359-364
- The significance of splenectomy for advanced proximal gastric cancer.Int J Surg Oncol. 2012; 2012301530
Published online: September 18, 2017
Accepted: September 6, 2017
☆Supported by National key clinical specialty discipline construction program of China (No. 649). Scientific and technological innovation joint capital projects of Fujian Province, China (No. 2016Y9031). The youth research project of Fujian Provincial Health and Family Planning Commission (2014-1-48).
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.