Spleen-Preserving Lymphadenectomy Versus Splenectomy in Laparoscopic Total Gastrectomy for Advanced Gastric Cancer

Abstract

Introduction: To investigate the optimal approach for laparoscopic splenic hilum lymph node dissection in advanced gastric cancer, we compared the operative outcomes between laparoscopic spleen-preserving total gastrectomy (sp-LTG) and laparoscopic total gastrectomy with splenectomy (sr-LTG). Methods: A retrospective case-control study was conducted between February 2006 and December 2012. The operative outcomes, the number of retrieved splenic hilum lymph node, complication, and patient survival were analyzed. Results: 112 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) and estimated blood loss (157 ml vs. 164 ml, p=0.817) 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 group and sr-LTG group (LN #10

1.78 vs. 3.21, p=0.033, LN #11d

1.41 vs. 2.76, p=0.004). The complication rate was 17.6% in sp-LTG group and 13.6% in sr-LTG group, respectively (p=0.572). In multivariate analysis, circular lesion and vascular invasion were independent prognostic factors related to overall survival, but splenectomy was not associated with overall survival (p=0.0.29, p=0.006, and p=0.453, respectively) Conclusions: sp-LTG may be the treatment of choice for splenic hilum lymph node dissection in advanced gastric cancer.