Qing Zhong1, Qi-Yue Chen1, 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-Po Xu11, Wen-Bin Zhang12, Jin Wan13, Pei-Wu Yu14, Jian-Kun Hu15, Xiang-Qian Su16, Jia-Fu Ji16, Zi-Yu Li16, Jun You17, Yong Li18, Lin Fan19, Chao-Hui Zheng1, Jian-Wei Xie1, Ping Li1, Chang-Ming Huang20. 1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China. 2. The First Hospital of Putian City, Putian, 351100, China. 3. Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong 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, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510515, China. 14. Department of General Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China. 15. Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Sichuan University, Chengdu, 610000, China. 16. Gastrointestinal Cancer Center, Beijing University Cancer Hospital, Beijing, 100142, China. 17. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361000, China. 18. Department of Gastrointestinal Surgery, Guangdong General Hospital, Guangzhou, 510515, China. 19. Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China. 20. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China. hcmlr2002@163.com.
Abstract
BACKGROUND: For patients with locally advanced proximal gastric cancer (LAPGC), the individualized selection of patients with highly suspected splenic hilar (No. 10) lymph node (LN) metastasis to undergo splenic hilar lymphadenectomy, is a clinical dilemma. This study aimed to re-evaluate the feasibility and safety of laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPSHL) and to identify the population who would benefit from it. METHODS: A total of 1068 patients (D2 group = 409; D2 + No. 10 group = 659) who underwent laparoscopic total gastrectomy from four prospective trials between January 2015 and July 2019 were analyzed. RESULTS: No significant difference in the incidence (16.9% vs. 16.4%; P = 0.837) of postoperative complications were found between the two groups. The metastasis rate of No. 10 LN among patients in the D2 + No. 10 group was 10.3% (68/659). Based on the decision tree, patients with LAPGC with tumor invading the greater curvature (Gre), patients with non-Gre-invading LAPGC with a tumor size > 5 cm and clinical positive locoregional LNs were defined as the high-priority No. 10 dissection group. The metastasis rate of No. 10 LNs in the high-priority group was 19.4% (41/211). In high-priority group, the 3-year overall survival of the D2 + No. 10 group was better than that of the D2 group (74.4% vs. 42.1%; P = 0.005), and the therapeutic index of No. 10 was higher than the indices of most suprapancreatic stations. CONCLUSIONS: LSPSHL for LAPGC is safe and feasible when performed by experienced surgeons. LSPSHL could be recommended for the high-priority group patients even without invasion of the Gre.
BACKGROUND: For patients with locally advanced proximal gastric cancer (LAPGC), the individualized selection of patients with highly suspected splenic hilar (No. 10) lymph node (LN) metastasis to undergo splenic hilar lymphadenectomy, is a clinical dilemma. This study aimed to re-evaluate the feasibility and safety of laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPSHL) and to identify the population who would benefit from it. METHODS: A total of 1068 patients (D2 group = 409; D2 + No. 10 group = 659) who underwent laparoscopic total gastrectomy from four prospective trials between January 2015 and July 2019 were analyzed. RESULTS: No significant difference in the incidence (16.9% vs. 16.4%; P = 0.837) of postoperative complications were found between the two groups. The metastasis rate of No. 10 LN among patients in the D2 + No. 10 group was 10.3% (68/659). Based on the decision tree, patients with LAPGC with tumor invading the greater curvature (Gre), patients with non-Gre-invading LAPGC with a tumor size > 5 cm and clinical positive locoregional LNs were defined as the high-priority No. 10 dissection group. The metastasis rate of No. 10 LNs in the high-priority group was 19.4% (41/211). In high-priority group, the 3-year overall survival of the D2 + No. 10 group was better than that of the D2 group (74.4% vs. 42.1%; P = 0.005), and the therapeutic index of No. 10 was higher than the indices of most suprapancreatic stations. CONCLUSIONS: LSPSHL for LAPGC is safe and feasible when performed by experienced surgeons. LSPSHL could be recommended for the high-priority group patients even without invasion of the Gre.
Entities:
Keywords:
Gastric cancer; Laparoscopic total gastrectomy; No. 10 station; Pooled analysis; Spleen-preserving splenic hilar lymphadenectomy