The splenic hilar lymph node (No. 10 LN) dissection is still controversial for patients with advanced proximal gastric cancer (APGC) not invading the greater curvature. We aim to evaluate the short-term outcomes of laparoscopic spleen-preserving No. 10 lymphadenectomy (LSPL) for APGC not invading the greater curvature and the characteristic of No. 10 LN metastasis.
Between January 2015 and December 2018, 536 APGC patients with clinical stage cT2-4a/N0-3/M0 not invading the greater curvature were enrolled and randomized to receive laparoscopy-assisted total gastrectomy with either D2 lymphadenectomy (D2 group) or D2 lymphadenectomy without No. 10 LN dissection (D2- group). The morbidity and mortality within 30 days after surgery, and number of retrieved LNs between the two groups were compared. Risk factors and the metastasis rate of No.10 LN were analyzed.
The present analysis included 263 patients in each group. There were no significant differences in the intraoperative and postoperative morbidity between the D2 and D2- groups (all P>0.05), and no mortality in both groups. There were more retrieved LNs in the D2 group than in the D2- group (45.1 vs 40.6, P=0.001). The metastasis rate of the No. 10 LN was 13.3% (35/263): 4.9% (2/41) in the early stage, and 14.9% (18/223) in the advanced stage. Pathological T (pT) stage and pN stage were related to No. 10 LN metastasis. The metastasis rates of No. 10 LN in T3-4a tumors located in the lesser curvature, posterior wall or multiple parts were all higher than 10%.
Experienced surgeons can safely perform LSPL for APGC with more retrieved LNs. For APGC located in the lesser curvature, posterior wall, or multiple parts with a clinical stage cT3-4a, the dissection of No.10 LN is recommended, but long-term follow-up is still required.
NCT02333721.
The authors.
Scientific and Technological Innovation Joint Capital Projects of Fujian Province.
All authors have declared no conflicts of interest.