title: Spleen preservation versus splenectomy in laparoscopic total gastrectomy with D2 lymphadenectomy for gastric cancer: A comparison of short-term outcomes.
abstract: BACKGROUND
  Splenic hilar lymph node dissection via a splenectomy for advanced proximal gastric cancer remains controversial. Recently, a laparoscopic spleen-preserving hilar lymph node dissection procedure was described in several publications. To assess the feasibility and safety of spleen-preserving laparoscopic total gastrectomy with D2 lymphadenectomy (LTG-D2), the present retrospective study compared the short-term surgical outcomes between spleen preservation and splenectomy during laparoscopic D2 total gastrectomy (LTG-D2S).
  
  
  METHODS
  This study included 59 patients who underwent LTG-D2 and 19 patients who underwent LTG-D2S.
  
  
  RESULTS
  The mean operation time did not significantly differ between the LTG-D2 and LTG-D2S groups (339.4 ± 56.8 vs 356.8 ± 46.0 min). The mean blood loss tended to be smaller in the LTG-D2 group than in the LTG-D2S group (105.9 ± 89.7 vs 210.0 ± 149.5 mL). The mean number of retrieved lymph nodes did not significantly differ between the LTG-D2 and LTG-D2S groups (39.9 ± 17.0 vs 40.6 ± 14.9), and the mean number of retrieved lymph nodes at the splenic hilum also did not significantly differ between the LTG-D2 and LTG-D2S groups (1.3 ± 1.7 vs 2.4 ± 2.6). Mild pancreatic fistula occurred in three cases (5%) in the LTG-D2 group and in three cases (15.8%) in the LTG-D2S group.
  
  
  CONCLUSIONS
  A LTG-D2 is feasible in terms of the short-term outcomes. However, the indications for this complicated procedure should be considered carefully.
authors.affiliation: Department of Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Usui
authors.affiliation: Department of Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Tashiro
authors.affiliation: Department of Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Haruki
authors.affiliation: Department of Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
authors.forename: Kaida
authors.initials: K
authors.lastname: Arita
authors.affiliation: Department of Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
authors.forename: Akiyo
authors.initials: A
authors.lastname: Matsumoto
authors.affiliation: Department of Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Takiguchi
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Advanced gastric cancer; laparoscopic total gastrectomy; spleen preservation