title: Comparison of different methods of splenic hilar lymph node dissection for advanced upper- and/or middle-third gastric cancer.
abstract: Surgery for advanced gastric cancer (AGC) often includes dissection of splenic hilar lymph nodes (SHLNs). This study compared the safety and effectiveness of different approaches to SHLN dissection for upper- and/or middle-third AGC.
  
  
  
  We retrospectively compared and analyzed clinicopathologic and follow-up data from a prospectively collected database at the Peking University Cancer Hospital. Patients were divided into three groups: in situ spleen-preserved, ex situ spleen-preserved and splenectomy.
  
  
  
  We analyzed 217 patients with upper- and/or middle-third AGC who underwent R0 total or proximal gastrectomy with splenic hilar lymphadenectomy from January 2006 to December 2011, of whom 15.2 % (33/217) had metastatic SHLNs, and from whom 11.4 % (53/466) of the dissected SHLNs were metastatic. The number of harvested SHLNs per patient was higher in the ex situ group than in the in situ group (P = 0.017). Length of postoperative hospital stay was longer in the splenectomy group than in the in situ group (P = 0.002) or the ex situ group (P < 0.001). The splenectomy group also lost more blood volume (P = 0.007) and had a higher postoperative complication rate (P = 0.005) than the ex situ group. Kaplan-Meier (log rank test) analysis showed significant survival differences among the three groups (P = 0.018). Multivariate analysis showed operation duration (P = 0.043), blood loss volume (P = 0.046), neoadjuvant chemotherapy (P = 0.005), and N stage (P < 0.001) were independent prognostic factors for survival.
  
  
  
  The ex situ procedure was more effective for SHLN dissection than the in situ procedure without sacrificing safety, whereas splenectomy was not more effective, and was less safe. The SHLN dissection method was not an independent risk factor for survival in this study.
authors.affiliation: Department of Gastrointestinal Surgery, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Haidian District Fucheng Road No. 52, Beijing, 100142, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Ji
authors.affiliation: Department of Gastrointestinal Surgery, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Haidian District Fucheng Road No. 52, Beijing, 100142, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Fu
authors.affiliation: Department of Gastrointestinal Surgery, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Haidian District Fucheng Road No. 52, Beijing, 100142, China.
authors.forename: Zhao-De
authors.initials: ZD
authors.lastname: Bu
authors.affiliation: Department of Gastrointestinal Surgery, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Haidian District Fucheng Road No. 52, Beijing, 100142, China.
authors.forename: Ji
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Haidian District Fucheng Road No. 52, Beijing, 100142, China.
authors.forename: Xiao-Jiang
authors.initials: XJ
authors.lastname: Wu
authors.affiliation: Department of Gastrointestinal Surgery, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Haidian District Fucheng Road No. 52, Beijing, 100142, China.
authors.forename: Xiang-Long
authors.initials: XL
authors.lastname: Zong
authors.affiliation: Department of Gastrointestinal Surgery, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Haidian District Fucheng Road No. 52, Beijing, 100142, China.
authors.forename: Zi-Yu
authors.initials: ZY
authors.lastname: Jia
authors.affiliation: Department of Gastrointestinal Surgery, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Haidian District Fucheng Road No. 52, Beijing, 100142, China.
authors.forename: Biao
authors.initials: B
authors.lastname: Fan
authors.affiliation: Department of Gastrointestinal Surgery, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Haidian District Fucheng Road No. 52, Beijing, 100142, China.
authors.forename: Yi-Nan
authors.initials: YN
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Haidian District Fucheng Road No. 52, Beijing, 100142, China. jijiafu_pku@163.com.
authors.forename: Jia-Fu
authors.initials: JF
authors.lastname: Ji
mesh_terms: D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013154:Spleen / Q000473:pathology; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Advanced gastric cancer; Splenectomy; Splenic hilar lymph node dissection; Splenic preservation