OBJECTIVETo explore the feasibility of laparoscopic spleen-preserving splenic hilar lymph node dissection for proximal gastric cancer.

METHODSThe clinical data of 18 patients of proximal gastric cancer underwent laparoscopic spleen-preserving splenic hilar lymph node dissection was analyzed from July to December 2010. There were 11 male and 7 female patients, with a mean age of (53 ± 11) years (range 28 to 64 years). All the patients underwent total gastrectomy with D2 lymph-node dissection. A complete macroscopic and microscopic resection (R0) was performed. Results in 18 cases, papillary adenocarcinoma was 2, tubular adenocarcinoma was 7, low differentiated adenocarcinoma was 6, mucous adenocarcinoma was 1 and carcinoid was 2. The TNM stages were distributed as follows: 7 in stage IIA, 9 in stage IIB and 2 in stage IIIA.

RESULTSSplenic lobar artery which came from splenic artery in the splenic hilar area entered the spleen. According to anatomic classification, splenic lobar artery was divided into three types. In the observation of 18 patients, the splenic lobar artery showed a single lobar artery in 1 case, two lobar arteries in 15 cases, and three lobar arteries in 2 cases. Laparoscopic spleen-preserving splenic hilar lymph node dissection was successfully performed for all patients without open conversion. The mean operation time was (271 ± 26) min (range 215 to 310 min), mean intraoperative blood loss was (96 ± 36) ml (range 55 to 150 ml), mean number of splenic hilar lymph nodes dissected was (3.6 ± 2.8) (range 1 to 11), and the mean postoperative hospital stay was (11.3 ± 1.8) d (range 9 to 16 d). Two patients experienced complications postoperatively, and there was no postoperative death. The entire cohort were followed up for 2 to 8 months, none of them had recurrence or metastasis.

CONCLUSIONLaparoscopic spleen-preserving splenic hilar lymph node dissection for proximal gastric cancer is technically feasible and safe.