• Sang-Yong Son, Dong Joon Shin, Young Suk Park, Aung Myint Oo, Do-Hyun Jung, Chang Min Lee, Sang-Hoon Ahn, Park Do Joong DJ Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Surgery, Seoul National University College of Med, and Hyung-Ho Kim.
• Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
• Surg Oncol. 2017 Jun 1; 26 (2): 207-211.

BackgroundTo investigate the optimal approach for laparoscopic splenic hilum lymph node dissection in proximal advanced gastric cancer, we compared the operative outcomes between laparoscopic spleen-preserving total gastrectomy (sp-LTG) and laparoscopic total gastrectomy with splenectomy (sr-LTG).MethodsA retrospective case-cohort study was conducted between February 2006 and December 2012. The operative outcomes, the number of retrieved splenic hilum lymph node, complication, and patients' survivals were analyzed.Results112 patients who underwent laparoscopic total gastrectomy with or without splenectomy for advanced gastric cancer were enrolled (68 sp-LTGs and 44 sr-LTGs). The mean operation time (227 min vs. 224 min, p = 0.762), estimated blood loss (157 ml vs. 164 ml, p = 0.817), and complication rate (17.6% vs. 13.6%, p = 0.572) were not different between two groups. Regarding splenic lymph node dissection, there were significantly differences in the mean number of retrieved lymph nodes between sp-LTG and sr-LTG (LN no.10; 1.78 vs. 3.21, p = 0.033, LN no.11d; 1.41 vs. 2.76, p = 0.004). The 5-year survivals were 77.3% in sp-LTG and 65.9% in sr-LTG (p = 0.240). The hazard ratio of splenectomy was 1.139 (95% confidence interval 0.514-2.526, p = 0.748).ConclusionIn laparoscopic total gastrectomy for proximal advanced gastric cancer, spleen-preserving hilar dissection showed comparable short-term and long-term outcomes.Copyright © 2017 Elsevier Ltd. All rights reserved.

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