Enlightenment and reflection of splenic hilar lymph node dissection for advanced proximal gastric cancer
10.3760/cma.j.issn.1673-9752.2020.01.008
- VernacularTitle: 进展期近端胃癌脾门淋巴结清扫的启示与思考
- Author:
Changming HUANG
1
;
Jianxian LIN
Author Information
1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Publication Type:Journal Article
- Keywords:
Gastric neoplasms;
Surgical procedure, operative;
Splenic hilar lymph node;
Lymphadenectomy;
Laparoscopy
- From:
Chinese Journal of Digestive Surgery
2020;19(1):50-54
- CountryChina
- Language:Chinese
-
Abstract:
Splenic hilar lymph node (LN) is the difficulty and focus of perigastric LN dissection during radical gastrectomy for advanced proximal gastric cancer (APGC). Although the new edition of Japanese Gastric Cancer Treatment Guidelines excluded the splenic hilar LN from the D2 lymphadenectomy in patients with APGC, there are still few high-level evidences. Meanwhile, the guideline recommends that splenectomy is still necessary for patients with APGC involving the greater curvature. With the support of increasing evidences, the spleen-preserving splenic hilar LN dissection has been recognized by more and more scholars. Additionally, the technique of laparoscopy provides a new method for splenic hilar LN dissection. Our center proposed a new technique named Huang′s three-step maneuver for laparoscopic spleen-preserving splenic hilar lymphadenectomy, which not only reduces the difficulty of operation, but also makes the technique easier to popularize and with a significance of minimally invasive effect. During the clinical practice, the dissection of LNs behind the splenic portal vessels is also one of the controversies. Therefore, the difficult technique of splenic hilar LN dissection not only requires us to make a technical exploration, but also requires us to explore precise indications, in order to avoid unnecessary operation in patients who do not require dissection of the No.10 LNs and to avoid missing the opportunity for radical surgery in high-risk patients because of the difficult techniques.
