Abstract: Objective:To investigate the clinical efficacy of Huang′s threestep maneuver in laparoscopic spleenpreserving splenic hilar (No.10 lymph node) lymphadenectomy for advanced proximal gastric cancer.
Methods:The clinical data of 122 patients who underwent laparoscopic spleenpreserving No.10 lymphadenectomy for advanced proximal gastric cancer by Huang′s threestep maneuver at the Affiliated Union Hospital of Fujian Medical University from March 2013 to December 2013 were retrospectively analyzed. All the patients received laparoscopyassisted radical total gastrectomy combined with spleenpreserving D2 lymph node dissection. The intraoperative and postoperative recoveries and complications of patients were analyzed. All patients were followed up by outpatient examination, visit, correspondence and telephone interview up to March 1, 2014.
Results:One patient received splenectomy due to intraoperative splenic artery injury and the other 121 patients received successfully laparoscopic spleenpreserving No.10 lymphadenectomy. The operation time, volume of intraoperative blood loss, time and volume of blood loss in No.10 lymphadenectomy were (175±27)minutes, (60±43)mL, (21±8)minutes and (15±13)mL, respectively. The total and mean numbers of lymph node dissection in 122 patients were 4 797 and 44±18, respectively. The total and mean numbers of No.10 lymph node dissection were 354 and 2.9±2.4, respectively. Thirtyseven No.10 lymph node metastases were detected in 15 patients, with a metastasis rate of 12.30%(15/122). The time to anal exsufflation, time for fluid diet intake, duration of hospital stay and incidence of complications were (4.0±0.8)days, (4.9±1.8)days, (12±7)days and 11.48%(14/122), respectively. All the 122 patients were followed up for a median time of 8 months (range, 2-12 months). No tumor recurrence, tumor metastasis and death were observed during followup.
Conclusions:Huang′s threestep maneuver simplifies the complicated surgical procedures of laparoscopic spleenpreserving No.10 lymphadenectomy for advanced proximal gastric cancer, its clinical efficacy is satisfactory with an advantage of clinical application.