Spleen preservation versus splenectomy in laparoscopic total gastrectomy with D2 lymphadenectomy for gastric cancer: A comparison of short-term outcomes

• Published in: Asian journal of endoscopic surgery Vol. 9; no. 1; pp. 5 - 13
• Main Authors: Usui, Shinsuke, Tashiro, Masaki, Haruki, Shigeo, Arita, Kaida, Ito, Koji, Matsumoto, Akiyo, Takiguchi, Noriaki
• Format: Journal Article
• Language: English
• Published: Japan Blackwell Publishing Ltd 01.02.2016; Wiley Subscription Services, Inc
• Subjects: Advanced gastric cancer; Aged; Anastomosis, Roux-en-Y; Female; Gastrectomy - methods; Humans; laparoscopic total gastrectomy; Laparoscopy - methods; Lymph Node Excision; Male; Middle Aged; Postoperative Complications; Retrospective Studies; spleen preservation; Splenectomy; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Treatment Outcome; laparoscopic total gastrectomy; Advanced gastric cancer; spleen preservation
• ISSN: 1758-5902; 1758-5910
• DOI: 10.1111/ases.12255

Introduction Splenic hilar lymph node dissection via a splenectomy for advanced proximal gastric cancer remains controversial. Recently, a laparoscopic spleen‐preserving hilar lymph node dissection procedure was described in several publications. To assess the feasibility and safety of spleen‐preserving laparoscopic total gastrectomy with D2 lymphadenectomy (LTG‐D2), the present retrospective study compared the short‐term surgical outcomes between spleen preservation and splenectomy during laparoscopic D2 total gastrectomy (LTG‐D2S). Method This study included 59 patients who underwent LTG‐D2 and 19 patients who underwent LTG‐D2S. Results The mean operation time did not significantly differ between the LTG‐D2 and LTG‐D2S groups (339.4 ± 56.8 vs 356.8 ± 46.0 min). The mean blood loss tended to be smaller in the LTG‐D2 group than in the LTG‐D2S group (105.9 ± 89.7 vs 210.0 ± 149.5 mL). The mean number of retrieved lymph nodes did not significantly differ between the LTG‐D2 and LTG‐D2S groups (39.9 ± 17.0 vs 40.6 ± 14.9), and the mean number of retrieved lymph nodes at the splenic hilum also did not significantly differ between the LTG‐D2 and LTG‐D2S groups (1.3 ± 1.7 vs 2.4 ± 2.6). Mild pancreatic fistula occurred in three cases (5%) in the LTG‐D2 group and in three cases (15.8%) in the LTG‐D2S group. Conclusion A LTG‐D2 is feasible in terms of the short‐term outcomes. However, the indications for this complicated procedure should be considered carefully.