title: Totally laparoscopic spleen-preserving splenic hilum lymph nodes dissection in radical total gastrectomy: an omnibearing method.
abstract: OBJECTIVE
  To investigate the feasibility and safety of laparoscopic spleen-preserving splenic hilum lymph nodes (LNs) dissection for advanced proximal gastric cancer using an omnibearing method.
  
  
  METHODS
  Between August 2013 and December 2014, 16 patients with advanced proximal gastric cancer treated in Guangdong Province Hospital of Chinese Medicine, were enrolled and subsequently underwent laparoscopic radical total gastrectomy (TG) with spleen-preserving splenic hilum LNs dissection. During dissecting Nos. 10 and 11 LNs, we divided them into two parts, namely LNs anterosuperior and posterior to the splenic vessel. The clinicopathological characteristics, intraoperative outcomes and postoperative courses were retrospectively collected and analyzed in the study.
  
  
  RESULTS
  Laparoscopic surgery was successfully completed in all 16 patients without conversion to open surgery, and no perioperative death occurred. The mean operating time was 328.75 ± 46.96 min, and the mean estimated blood loss was 135.63 ± 62.07 ml. One patient experienced intraoperative bleeding due to the splenic vein injury which was successfully handled with laparoscopic vessel suturing, and one postoperative pulmonary infection was recorded. The mean time to first flatus was 3.56 ± 1.03 days with a mean 9.63 ± 1.50 days of postoperative hospital stay. The mean number of retrieved LNs was 28.31 ± 5.99, in which LNs anterosuperior to splenic artery was 2.88 ± 2.66 and LNs posterior was 1.38 ± 1.75.
  
  
  CONCLUSIONS
  Laparoscopic TG with spleen-preserving splenic hilum LNs dissection using an omnibearing method for advanced proximal gastric cancer was safe and technically feasible in experienced hands. Further studies in terms of its clinical significance are needed.
authors.affiliation: Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China. xiongwj1988@163.com.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Xiong
authors.affiliation: Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China.
authors.forename: Yansheng
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China.
authors.forename: Lijie
authors.initials: L
authors.lastname: Luo
authors.affiliation: Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China.
authors.forename: Dechang
authors.initials: D
authors.lastname: Diao
authors.affiliation: Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China. gdphtcmwanjin@163.com.
authors.forename: Jin
authors.initials: J
authors.lastname: Wan
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000601:surgery*; D061887:Conversion to Open Surgery; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013154:Spleen / Q000601:surgery*; D013157:Splenic Artery; D013162:Splenic Vein / Q000293:injuries / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery*; D013536:Suture Techniques
keywords: Gastric cancer; Laparoscopy; Spleen-preserving; Splenic hilum lymph node dissection; Total gastrectomy