The effect of spleen‐preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer

Oh, Sung Jin; Hyung, Woo Jin; Li, Chen; Song, Ji‐Won; Kang, Wook Ho; Rha, Sun Young; Chung, Hyun Cheol; Choi, Seung Ho; Noh, Sung Hoon

doi:10.1002/jso.21229

Cited by 51 publications

(37 citation statements)

References 23 publications

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“…Because combined splenectomy increased the risk of postoperative morbidity and mortality in randomized clinical trials and could not show survival benefit compared with spleen preservation (22)(23)(24)(25), routine or prophylactic splenectomy is not recommended by National Comprehensive Cancer Network guidelines (28). Recently, a large, multicenter, randomized controlled trial with 505 patients comparing splenectomy with spleen preservation on the proximal gastric cancer was performed (29,30).…”

Section: Discussionmentioning

confidence: 99%

“…Because prophylactic combined resection of spleen increased the risk of postoperative morbidity (22,23) with no survival benefit (24,25) in open total gastrectomy, the reports on LTG with splenectomy were limited (19)(20)(21). There were only small case series so far.…”

Section: Ltg With Splenectomy (Tables 23)mentioning

confidence: 99%

“…Because of the variation of the vascular anatomy in the splenic hilum and with the concern of pancreasrelated complications, splenic hilar lymphadenectomy is technically challenging even for skilled surgeons. Based on the evidence that prophylactic combined resection of spleen in total gastrectomy increased the risk of postoperative morbidity (22,23) or had no survival benefit (24,25), surgeons have preferred laparoscopic spleenpreserving splenic hilar lymphadenectomy (LSPL) (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) rather than LTG with splenectomy (20,21). Since the first report by Hyung et al (8) in 2008, the number of studies with acceptable feasibility of LSPL has increased (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic splenic hilar lymphadenectomy for advanced gastric cancer

Hosogi

Okabe

Shinohara

et al. 2016

Transl. Gastroenterol. Hepatol.

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Laparoscopic distal gastrectomy has recently become accepted as a surgical option for early gastric cancer in the distal stomach, but laparoscopic total gastrectomy (LTG) has not become widespread because of technical difficulties of esophagojejunal anastomosis and splenic hilar lymphadenectomy. Splenic hilar lymphadenectomy should be employed in the treatment of advanced proximal gastric cancer to complete D2 dissection, but laparoscopically it is technically difficult even for skilled surgeons. Based on the evidence that prophylactic combined resection of spleen in total gastrectomy increased the risk of postoperative morbidity with no survival impact, surgeons have preferred laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) for advanced tumors without metastasis to splenic hilar nodes or invasion to the greater curvature of the stomach, and reports with LSPL have been increasing rather than LTG with splenectomy. In this paper, recent reports with laparoscopic splenic hilar lymphadenectomy were reviewed.

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Section: Discussionmentioning

confidence: 99%

Section: Ltg With Splenectomy (Tables 23)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Laparoscopic splenic hilar lymphadenectomy for advanced gastric cancer

Hosogi

Okabe

Shinohara

et al. 2016

Transl. Gastroenterol. Hepatol.

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“…Retrospective studies that report survival data with subgroup analysis are listed in Appendix B in the Electronic supplementary material. Positive lymph nodes in the splenic artery and hilum were associated with decreased survival [15,19,22,44,48]. Extended lymphadenectomy with spleen resection for patients was associated with decreased survival in one study compared to spleen preservation when these nodes were positive [44].…”

Section: Overall Survivalmentioning

confidence: 99%

“…Positive lymph nodes in the splenic artery and hilum were associated with decreased survival [15,19,22,44,48]. Extended lymphadenectomy with spleen resection for patients was associated with decreased survival in one study compared to spleen preservation when these nodes were positive [44]. R0 resection was associated with improved survival in patients in two studies [14,42].…”

Section: Overall Survivalmentioning

confidence: 99%

A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

et al. 2011

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Background The overall prognosis and survival of patients with advanced gastric cancer are generally poor. Extended lymphadenectomy is recommended for patients with advanced gastric cancer; however, splenectomy and distal pancreatectomy performed with an extended lymph node dissection may be associated with increased morbidity and mortality. Method Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 31 December 2009. Studies on gastric carcinoma investigating extended lymphadenectomy with splenectomy and/or pancreaticosplenectomy that reported data on surgical outcomes or survival were selected. Results Forty studies were included in this review. Decreased complication rates were demonstrated with spleen preservation in two prospective studies and three retrospective studies, and with pancreas preservation in five retrospective studies. No randomized controlled trial showed survival benefit or detriment for preservation of spleen or pancreas in extended lymphadenectomy. Improved survival was demonstrated with spleen preservation in two prospective and eight retrospective studies, and with pancreas preservation in one prospective and four retrospective studies. Conclusions Preservation of the spleen and pancreas during extended lymphadenectomy for gastric cancer decreases complications with no clear evidence of improvement or detriment to overall survival.

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Current status of laparoscopic total gastrectomy

Kawaguchi

Shiraishi

Akaike

et al. 2018

Annals of Gastroent Surgery

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In this article, the current state of laparoscopic total gastrectomy (LTG) was reviewed, focusing on lymph node dissection and reconstruction. Lymph node dissection in LTG is technically similar to that in laparoscopic distal gastrectomy for early gastric cancer; however, LTG for advanced gastric cancer requires extended lymph node dissections including splenic hilar lymph nodes. Although a recent randomized controlled trial clearly indicated no survival benefit in prophylactic splenectomy for lymph node dissection at the splenic hilum, some patients may receive prognostic benefit from adequate splenic hilar lymph node dissection. Considering reconstruction, there are two major esophagojejunostomy (EJS) techniques, using a circular stapler (CS) or using a linear stapler (LS). A few studies have shown that the LS method has fewer complications; however, almost all studies have reported that morbidity (such as anastomotic leakage and stricture) is not significantly different for the two methods. As for CS, we grouped various studies addressing complications in LTG into categories according to the insertion procedure of the anvil and the insertion site in the abdominal wall for the CS. We compared the rate of complications, particularly for leakage and stricture. The rate of anastomotic leakage and stricture was the lowest when inserting the CS from the upper left abdomen and was significantly the highest when inserting the CS from the midline umbilical. Scrupulous attention to EJS techniques is required by surgeons with a clear understanding of the advantages and disadvantages of each anastomotic device and approach.

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The effect of spleen‐preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer

Cited by 51 publications

References 23 publications

Laparoscopic splenic hilar lymphadenectomy for advanced gastric cancer

Laparoscopic splenic hilar lymphadenectomy for advanced gastric cancer

A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

Current status of laparoscopic total gastrectomy

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