Chao-Hui Zheng1, Yan-Chang Xu2, Gang Zhao3, Li-Sheng Cai4, Guo-Xin Li5, Ze-Kuan Xu6, Su Yan7, Zu-Guang Wu8, Fang-Qin Xue9, Yi-Hong Sun10, Dong-Bo Xu11, Wen-Bin Zhang12, Pei-Wu Yu13, Jian-Kun Hu14, Xiang-Qian Su15, Jia-Fu Ji15, Zi-Yu Li15, Jun You16, Yong Li17, Chang-Ming Huang18. 1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China. 2. Fujian Medicine University, Teaching Hospital, The First Hospital of PuTian City, Putian, 351100, China. 3. Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. 4. Department of General Surgery Unit 4, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian, China. 5. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China. 6. Department of General Surgery, Jiangsu Province Hospital, Nanjing Medical University, Nanjing, 210000, China. 7. Department of Gastrointestinal Surgery, Affiliated Hospital of Qinghai University, Qinghai Medical University, Xining, 810000, China. 8. Department of General Surgery Unit 2, Meizhou People's Hospital of Guangdong, Meizhou, 514021, China. 9. Department of Gastrointestinal Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China. 10. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. 11. Department of General Surgery, Longyan First Hospital, Longyan, 364000, China. 12. Department of General Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Wulumuqi, 830001, China. 13. Department of General Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China. 14. Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Sichuan University, Chengdu, 610000, China. 15. Gastrointestinal Cancer Center, Beijing University Cancer Hospital, Beijing, 100142, China. 16. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361000, China. 17. Department of Gastrointestinal Surgery, Guangdong General Hospital, Guangzhou, 510515, China. 18. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China. hcmlr2002@163.com.
Abstract
BACKGROUND: Previous retrospective studies have shown that laparoscopic spleen-preserving D2 total gastrectomy (LSTG) for advanced upper third gastric cancer (AUTGC) is safe. However, all previous studies were underpowered. We therefore conducted a prospective, multicenter study to evaluate the technical safety and feasibility of LSTG for patients with AUTGC. METHODS:Patients diagnosed with AUTGC (cT2-4a, N-/+, M0) underwent LSTG at 19 institutions between September 2016 and October 2017 were included. The number of No. 10 lymph node (LN) dissections, metastasis rates, intraoperative and postoperative complications were investigated. RESULTS:A total of 251 patients were enrolled in the study, and 242 patients were eligible for the per protocol analysis. The average numbers of No. 10 LN dissections and metastases were 2.4 and 0.1, respectively. Eighteen patients (7.4%) had No. 10 LN metastases, and among patients with advanced gastric cancer, the rate of No. 10 LN metastasis was 8.1% (18/223). pN3 status was an independent risk factor for No. 10 LN metastasis. Intraoperative complications occurred in 7 patients, but no patients required conversion to open surgery or splenectomy. The overall postoperative complication rate was 13.6% (33/242). The major complication and mortality rates were 3.3% (8/242) and 0.4% (1/242), respectively. The number of retrieved No. 10 LNs, No. 10 LN metastasis and TNM stage had no significant influence on postoperative complication rates. CONCLUSION:LSTG for AUTGC was safe and effective when performed by very experienced surgeons, this technique could be used in patients who needed splenic hilar lymph node dissection.
RCT Entities:
BACKGROUND: Previous retrospective studies have shown that laparoscopic spleen-preserving D2 total gastrectomy (LSTG) for advanced upper third gastric cancer (AUTGC) is safe. However, all previous studies were underpowered. We therefore conducted a prospective, multicenter study to evaluate the technical safety and feasibility of LSTG for patients with AUTGC. METHODS:Patients diagnosed with AUTGC (cT2-4a, N-/+, M0) underwent LSTG at 19 institutions between September 2016 and October 2017 were included. The number of No. 10 lymph node (LN) dissections, metastasis rates, intraoperative and postoperative complications were investigated. RESULTS: A total of 251 patients were enrolled in the study, and 242 patients were eligible for the per protocol analysis. The average numbers of No. 10 LN dissections and metastases were 2.4 and 0.1, respectively. Eighteen patients (7.4%) had No. 10 LNmetastases, and among patients with advanced gastric cancer, the rate of No. 10 LN metastasis was 8.1% (18/223). pN3 status was an independent risk factor for No. 10 LN metastasis. Intraoperative complications occurred in 7 patients, but no patients required conversion to open surgery or splenectomy. The overall postoperative complication rate was 13.6% (33/242). The major complication and mortality rates were 3.3% (8/242) and 0.4% (1/242), respectively. The number of retrieved No. 10 LNs, No. 10 LN metastasis and TNM stage had no significant influence on postoperative complication rates. CONCLUSION: LSTG for AUTGC was safe and effective when performed by very experienced surgeons, this technique could be used in patients who needed splenic hilar lymph node dissection.
Authors: Ugoeze Nwokedi; Duc T Nguyen; Leonora M Meisenbach; Ray Chihara; Edward Y Chan; Edward A Graviss; Min P Kim Journal: Surg Endosc Date: 2020-07-14 Impact factor: 4.584