title: Laparoscopic spleen-preserving hilar lymph node dissection through pre-pancreatic and retro-pancreatic approach in patients with gastric cancer.
abstract: BACKGROUND
  The conventional radical resection of proximal gastric cancer is even more risky when performed laparoscopically, though this technique is widely used in gastrointestinal surgery and is accepted as the superior method. This paper explores the feasibility of laparoscopic spleen-preserving hilar lymph node dissection using a retro-pancreatic approach for the treatment of proximal gastric cancer.
  
  
  METHODS
  Two cadavers were dissected for examination of and the pre-pancreatic and retro-pancreatic spaces. Following the dissection of the cadavers, ten live patients with proximal gastric cancer from May 2008 to May 2013 at Nanfang Hospital, Guangzhou, China, were given total gastrectomy and adjuvant splenic hilar lymph node clearance through pre-pancreatic and retro-pancreatic approach on the precondition of preserving the pancreas and spleen. The clinicopathologic characteristics, as well as the intraoperative and postoperative variables affecting the procedure, were observed and analyzed.
  
  
  RESULTS
  Anatomy of the space anterior and posterior to the pancreas in the two cadavers demonstrated the feasibility of pre-pancreatic and retro-pancreatic approach. The surgeries were all successfully performed laparoscopically; conversion to laparotomy was not necessary for any of the ten patients. The overall mean operative time was 243.6 ± 45 min. The mean estimated blood loss was 232 ± 80 ml. At the time of follow-up (median 12 months post-surgery), there had been neither local recurrence nor mortality in any of the patients.
  
  
  CONCLUSIONS
  Laparoscopic spleen- and pancreas-preserving splenic hilar lymph node dissection during total gastrectomy, using both pre-pancreatic and retro-pancreatic approaches, is indicated as a safe and feasible method for the treatment of proximal gastric cancer.
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China.|Department of General Surgery, Tumor Hospital of Baotou, Baotou, 014030 Inner Mongolia Autonomous Region China.
authors.forename: Liansheng
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China.
authors.forename: Ce
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China.|The Key Laboratory of Cancer Prevention and Intervention, Department of Surgical Oncology, China National Ministry of Education, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jie-Fang Rd, Hangzhou, 310009 Zhejiang Province China.
authors.forename: Da
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Xue
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China.
authors.forename: Ke-Jian
authors.initials: KJ
authors.lastname: Zhou
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China.
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China.
authors.forename: Guoxin
authors.initials: G
authors.lastname: Li
keywords: Gastric cancer; Laparoscopy; Lymph node dissection; Splenic hilum