title: Laparoscopic spleen-preserving splenic hilar lymphadenectomy in 108 consecutive patients with upper gastric cancer.
abstract: OBJECTIVE
  To evaluate the feasibility and short-term efficacy of laparoscopic spleen-preserving splenic hilar (No. 10) lymphadenectomy to treat advanced upper gastric cancer (AUGC).
  
  
  METHODS
  Between January and December 2012, 108 laparoscopic spleen-preserving No. 10 lymphadenectomy along with total gastrectomy with routine D2 lymphadenectomy were performed consecutively at our hospital to treat clinical T2-3 (cT2-3) upper gastric cancers. The preoperative clinical T stage was cT2 in 36 patients and cT3 in 72 patients. A prospectively designed database tracked the 108 patients, including the completeness of their medical records and the adequacy of follow-up. Patient clinicopathological characteristics, intraoperative and postoperative surgical outcomes, morbidity and mortality, lymph node (LN) dissection, and postoperative follow-up were analysed retrospectively.
  
  
  RESULTS
  Laparoscopic spleen-preserving No. 10 lymphadenectomy was successful in all 108 patients. The mean operation time was 169.3 ± 27.1 min, and the mean No. 10 lymphadenectomy time was 20.0 ± 5.7 min. The mean total blood loss was 46.2 ± 11.3 mL, and the mean blood loss from No. 10 lymphadenectomy was 14.3 ± 3.8 mL. The mean postoperative hospital stay was 11.9 ± 6.0 d. The intraoperative and postoperative morbidity rates were 3.7% and 12.0%, respectively; however, there was no postoperative mortality. A mean of 44.4 ± 17.6 LNs were retrieved from each specimen, including 3.0 ± 2.4 No. 10 LNs. Three patients (2.8%) with cT3 cancer had LN metastasis of the splenic hilus, including two patients with pathological T3 (pT3) and one patient with pathological T4a (pT4a) tumours, all located in the greater curvature. No splenic hilar LNs metastasis was evident in the patients with pT1 and pT2 tumours. At a median follow-up time of 18 mo (range, 12 to 23 mo), all patients were alive and none had experienced recurrent or metastatic disease.
  
  
  CONCLUSIONS
  Laparoscopic spleen-preserving No. 10 lymphadenectomy is feasible and effective to treat AUGC. Routine No. 10 lymphadenectomy may be unnecessary for AUGC without serosa invasion, unless T3 tumours are located in the greater curvature.
authors.affiliation: Ping Li, Chang-Ming Huang, Chao-Hui Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Yi Wang, Qi-Yue Chen, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Ping Li, Chang-Ming Huang, Chao-Hui Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Yi Wang, Qi-Yue Chen, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China.
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Huang
authors.affiliation: Ping Li, Chang-Ming Huang, Chao-Hui Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Yi Wang, Qi-Yue Chen, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China.
authors.forename: Chao-Hui
authors.initials: CH
authors.lastname: Zheng
authors.affiliation: Ping Li, Chang-Ming Huang, Chao-Hui Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Yi Wang, Qi-Yue Chen, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China.
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Xie
authors.affiliation: Ping Li, Chang-Ming Huang, Chao-Hui Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Yi Wang, Qi-Yue Chen, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China.
authors.forename: Jia-Bin
authors.initials: JB
authors.lastname: Wang
authors.affiliation: Ping Li, Chang-Ming Huang, Chao-Hui Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Yi Wang, Qi-Yue Chen, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China.
authors.forename: Jian-Xian
authors.initials: JX
authors.lastname: Lin
authors.affiliation: Ping Li, Chang-Ming Huang, Chao-Hui Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Yi Wang, Qi-Yue Chen, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.affiliation: Ping Li, Chang-Ming Huang, Chao-Hui Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Yi Wang, Qi-Yue Chen, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Ping Li, Chang-Ming Huang, Chao-Hui Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Yi Wang, Qi-Yue Chen, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China.
authors.forename: Qi-Yue
authors.initials: QY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Gastrectomy; Lymphadenectomy; Spleen-preservation; Stomach neoplasms; laparoscopy