title: Procedure for lymph node dissection around splenic artery in proximal gastric cancer.
abstract: OBJECTIVE
  The effect of lymph node metastasis around the splenic artery on the prognosis of proximal gastric cancer patients is not confirmed. The aim of this study is to clarify the optimal procedure for lymph node dissection along the splenic artery in proximal gastric cancer.
  
  
  METHODS
  Proximal gastric cancer patients who underwent total gastrectomy with pancreaticosplenectomy were examined. The anatomical location of lymph nodes and the metastases around the pancreas were also studied in pancreatic cancer patients who underwent total pancreatectomy.
  
  
  RESULTS
  Multivariate analysis of lymph node metastasis around the splenic artery showed that No. 11 lymph node metastasis was affected by No.10 lymph node that was predicted by depth of invasion. Multivariate analysis of prognostic variables by Cox's proportional hazard regression revealed that No. 10 lymph node metastasis was the significant factor affecting prognosis. No lymph node metastasis infiltrating the pancreatic parenchyma was observed in the pancreatic body or the tail.
  
  
  CONCLUSIONS
  Total gastrectomy preserving the pancreas and spleen is the optimal procedure in proximal T2 gastric cancer. Total gastrectomy with splenectomy is appropriate in T3 cases, and distal pancreatectomy should be additionally done only in cases of direct invasion by the lymph node and/or the tumor to the pancreas.
authors.affiliation: Department of Gastroenterological Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. ohno@med.kobe-u.ac.jp
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ohno
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakamura
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ajiki
authors.forename: Hideki
authors.initials: H
authors.lastname: Horiuchi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Tabuchi
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kuroda
mesh_terms: D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D016016:Proportional Hazards Models; D012307:Risk Factors; D013156:Splenectomy; D013157:Splenic Artery / Q000473:pathology*; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery