title: Early results of a modified splenic hilar lymphadenectomy in laparoscopy-assisted total gastrectomy for gastric cancer with stage cT1-2: a case-control study.
abstract: BACKGROUND
  The aim of this study was to explore the feasibility and early outcomes of laparoscopy-assisted total gastrectomy with a modified splenic hilar lymphadenectomy for upper- and middle-third stage cT1-2 gastric cancer.
  
  
  METHODS
  A total of 97 patients diagnosed with upper- and middle-third stage cT1-T2 gastric cancer were enrolled. Patients were assigned to the laparoscopy-assisted total gastrectomy group (LATG, n = 41) or the open total gastrectomy group (OTG, n = 56). All patients underwent total gastrectomy with modified splenic hilar lymphadenectomy. The operative and postoperative measures, number of retrieved lymph nodes (LNs), and complications were compared between the two groups.
  
  
  RESULTS
  The mean number of dissected LNs was not significantly different between the two groups: 23.1 ± 8.0 in the LATG group versus 24.2 ± 7.5 in the OTG group. Compared with the OTG group, the LATG group had less operative blood loss [104.2 ± 42.9 vs. 355.6 ± 51.3 ml (p < 0.0001)], shorter time to out-of-bed activities [14.4 ± 3.2 vs. 16.5 ± 1.2 h (p < 0.0001)], shorter time to first flatus [72.2 ± 16.2 vs. 78.4 ± 8.6 h (p = 0.017)], earlier resumption of soft diet [52.8 ± 21.6 vs. 74.2 ± 12.2 h (p < 0.0001)], and shorter postoperative hospital stay [9.7 ± 2.2 vs. 13.6 ± 3.6 days (p < 0.0001)]. However, LATG had a slightly longer operating time than OTG [235.7 ± 38.5 vs. 211.5 ± 33.2 min (p = 0.001)]. The operative complications rates for the LATG and OTG groups were not significantly different: 4.9 versus 5.4 %.
  
  
  CONCLUSIONS
  For upper- and middle-third stage cT1-2 gastric cancer, a limited splenic hilar lymphadenectomy strategy seems to be safe and feasible, particularly for the number of retrieved LNs. However, this technique is not suitable for cT3 disease.
authors.affiliation: Department of General Surgery, Union Hospital, Fujian Medical University, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China. gxguan1108@126.com
authors.forename: Guoxian
authors.initials: G
authors.lastname: Guan
authors.forename: Weizhong
authors.initials: W
authors.lastname: Jiang
authors.forename: Zhifen
authors.initials: Z
authors.lastname: Chen
authors.forename: Xing
authors.initials: X
authors.lastname: Liu
authors.forename: Huishan
authors.initials: H
authors.lastname: Lu
authors.forename: Xiangfu
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D013274:Stomach Neoplasms / Q000601:surgery*