title: Laparoscopic pancreas- and spleen-preserving D2 lymph node dissection in advanced (cT2) upper-third gastric cancer.
abstract: OBJECTIVE
  Although the laparoscopic assisted total gastrectomy (LATG) has been performed in upper gastric cancer, dissection of lymph nodes No. 10 and 11d without resection of the distal pancreas and the spleen has been hard to accomplish, because of the possibilities of injury to splenic vessels and parenchyma of the spleen or pancreas. Herein, we present successful results in laparoscopic pancreas- and spleen-preserving D2 lymph node dissection in advanced upper gastric cancer.
  
  
  METHODS
  Between March 2004 and May 2007, 18 clinical T2 patients who underwent LATG with D2 lymph node dissection for upper gastric cancer were enrolled.
  
  
  RESULTS
  We used the technique of encircling and pulling the splenic artery with umbilical tape and that helped us complete dissection of lymph nodes No. 10 and 11d without distal pancreatectomy or splenectomy. The mean operative time was 370 min without any perioperative complications or conversion to an open procedure.
  
  
  CONCLUSIONS
  Laparoscopic extended lymph node dissection without pancreatectomy or splenectomy can be adapted to the patients with clinical T2 upper gastric cancer. The techniques like taping of the splenic artery can be a useful tip for surgeons who wish to perform laparoscopic complete D2 lymph node dissection in advanced upper gastric cancer.
authors: Department of Surgery, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Wonmi-Gu, Bucheon-City, Kyunggi-Do, Korea.
authors: Hoon
authors: H
authors: Hur
authors: Hae Myung
authors: HM
authors: Jeon
authors: Wook
authors: W
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D004210:Dissection / Q000379:methods; D004947:Esophagus / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007583:Jejunum / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010179:Pancreas / Q000473:pathology*; D011183:Postoperative Complications; D011446:Prospective Studies; D013154:Spleen / Q000473:pathology*; D013157:Splenic Artery / Q000473:pathology; D013274:Stomach Neoplasms / Q000601:surgery*; D053832:Surgical Tape; D013997:Time Factors