Abstract: Objective:To investigate the feasibility and safety of spleenpreserving No.10 and 11 lymph nodes dissection in the D₂ radical gastrectomy for gastric cancer.
Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 32 patients with advanced proximal gastric carcinoma who were admitted to the Third Affiliated Hospital of Anhui Medical University from January 2013 to May 2016 were collected. All the patients underwent open D₂ radical total gastrectomy and spleenpreserving No.10 and 11 lymph nodes dissection by the same operation team. Observation indicators included operation time, volume of intraoperative blood loss, time of No.10 and 11 lymph nodes dissection, number of lymph nodes dissection, number of positive lymph nodes, positive rate of lymph nodes, lymph node metastasis rate, histological classification, pTNM staging, duration of postoperative hospital stay, postoperative complications (splenic translocation, splenic torsion, splenic infarction, anastomotic leakage, pancreatic leakage and lymphorrhagia) and followup. The followup using outpatient examination and telephone interview was performed to detect the oncologic prognosis up to September 2016. Measurement data with normal distribution were represented as ±s. Count data were represented as a ratio.
Results:Among the 32 patients, gastric body cancer and cardiac cancer were respectively detected in 12 and 20 patients, they received open radical total gastrectomy and spleenpreserving No.10 and 11 lymph nodes dissection. The operation time and volume of intraoperative blood loss were (242±34)minutes and (98±67)mL. Time of lymph nodes dissection, number of lymph nodes dissection, number of positive lymph nodes, positive rate of lymph nodes and lymph node metastasis rate were (30±12)minutes, 141 (3.8±2.4), 22, 15.60%(22/141), 18.75%(6/32) in No.10 lymph nodes and (8±3)minutes, 168 (4.0±3.6), 36, 21.43%(36/168), 25.00%(8/32) in No.11 lymph nodes, respectively. Histological classification of 32 patients: highdifferentiated adenocarcinoma, moderatedifferentiated adenocarcinoma and lowdifferentiated adenocarcinoma were detected in 8, 14 and 10 patients, respectively. Seventeen and 15 patients were in stage ⅡB and ⅢA of pTNM staging. Duration of postoperative hospital stay in 32 patients was (12.9± 1.8)days. All the 32 patients were not complicated with splenic translocation, splenic torsion, splenic infarction, anastomotic leakage, pancreatic leakage and death, they were cured and discharged from hospital and then received simultaneously 6-8 cycles of chemotherapy of SOX regimen. One patient with lymphorrhagia had selfhealing at 3 weeks postoperatively by drainage. All the patients were followed up for 4-44 months, without the occurrence of tumor recurrence or metastasis and death.
Conclusion:Spleenpreserving No.10 and 11 lymph nodes dissection is safe and feasible in the D₂ radical gastrectomy for gastric cancer, and it should be widely spread in clinic.