Objective: To investigate the safety and efficacy of laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection in treatment of patients with advanced proximal gastric cancer.
Methods: The clinical data of 169 patients with advanced proximal gastric cancer who underwent laparoscopic spleen-preserving splenic hilar lymph node dissection in the First Division of the Gastrointestinal Surgery of the First Hospital of Putian City from January 2014 to January 2018 were retrospectively analyzed. Of the patients, 92 cases underwent laparoscopic anterior splenic hilar lymph node dissection (control group), while the other 77 cases underwent laparoscopic circumferential splenic hilar lymph node dissection, namely, underwent the conventional anterior splenic hilar lymph node dissection simultaneously with posterior splenic hilar lymph node dissection (observation group). The main clinical variables between the two groups of patients were compared.
Results: The baseline data between the two groups of patients were comparable. There were no significant differences between the two groups in terms of total operative time, intraoperative blood loss, time to postoperative gas passage, time to postoperative liquid food intake, length of postoperative hospital stay and number of positive lymph nodes (all P>0.05). In observation group compared with control group, the time for splenic hilar lymph node dissection was significantly prolonged, but the number of total dissected lymph nodes, the number of cases with positive splenic hilar lymph nodes and total number of harvested splenic hilar lymph nodes were significantly increased (all P<0.05). The incidence rates of complication showed no significant difference between the two groups (P>0.05). No perioperative death occurred in the two groups.
Conclusion: Laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection is safe and effective for patients with advanced proximal gastric cancer, and it can help avoid the incomplete dissection of positive splenic hilar lymph nodes.