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Research Article| Volume 43, ISSUE 12, P2357-2365, December 2017

Is it necessary to dissect the posterior lymph nodes along the splenic vessels during total gastrectomy with D2 lymphadenectomy for advanced gastric cancer?

  • Jian-Xian Lin
    Affiliations
    Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China

    Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
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  • Chang-Ming Huang
    Correspondence
    Corresponding author. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian Province, China.
    Affiliations
    Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China

    Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
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  • Chao-Hui Zheng
    Affiliations
    Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
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  • Ping Li
    Affiliations
    Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China

    Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
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  • Jian-Wei Xie
    Affiliations
    Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
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  • Jia-Bin Wang
    Affiliations
    Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China

    Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
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  • Jun Lu
    Affiliations
    Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
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  • Qi-Yue Chen
    Affiliations
    Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
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  • Long-Long Cao
    Affiliations
    Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
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  • Mi Lin
    Affiliations
    Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
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Published:September 18, 2017DOI:https://doi.org/10.1016/j.ejso.2017.09.008

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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).

      Conclusions

      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.

      Keywords

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