Laparoscopic Versus Open Radical total Gastrectomy with Pancreas- and Spleen-preserving Splenic Hilum Lymph Nodes Dissection for Proximal Advanced Gastric Cancer

Wei Wang, Wen Jun Xiong, Dechang Diao, Yansheng Zheng, Lijie Luo, Jin Wan. Guangdong Province Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Objective: To investigate the safety and feasibility of laparoscopic radical total gastrectomy with pancreas- and spleen-preserving splenic hilum lymph node dissection for proximal advanced gastric cancer, and to compare the early results of this procedure with open approach. 

Methods: Between January 2013 and December 2014, 45 patients with upper third or middle third gastric cancer underwent total gastrectomy with modified splenic hilar lymphadenectomy were enrolled. Patients were assigned to the laparoscopy-assisted total gastrectomy group (LATG, n = 15) or the open total gastrectomy group (OTG, n = 30). The operative and postoperative measures, number of retrieved lymph nodes (LNs), and complications were compared between the two groups. 

Results: Compared with the OTG group, the LATG group had less operative blood loss [130.9±38.3 versus 224.0±51.6 ml (P<0.001)], shorter time to ?rst ?atus [3.5±0.8 vs. 4.9±1.2 d (P<0.001)], earlier resumption of liquid diet [4.3±0.6 vs. 5.2±1.1 h (P<0.001)], and shorter postoperative hospital stay [9.7±1.7 vs. 12.7±4.7 days (P<0.001)]. The mean number of dissected LNs (26.1±8.8 in the LATG group vs. 33.4±13.4 in the OTG group) and postoperative complications rates (6.7% vs. 10%) were not signi?cantly different between LATG and OTG groups. However, LATG had a longer operating time than OTG [354.1±27.7 vs. 252.5±30.1 min (p<0.001)]. 

Conclusion: Laparoscopic radical total gastrectomy with pancreas- and spleen-preserving splenic hilum LNs dissection is a safe and feasible procedure and has better early results than traditional open approach.

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