Application value of page‑turning splenic hilum lymph node dissection technique in laparos-copic total gastrectomy with D₂ lymphadenectomy

Objective To investigate the application value of page‑turning splenic hilum lymph node dissection technique in laparoscopic total gastrectomy with D₂ lymphadenectomy.

Methods The retrospective and descriptive study was conducted. The clinicopathological data of 12 patients who underwent laparoscopic total gastrectomy with D₂ lymphadenectomy at two medical centers, including 11 patients at The First Affiliated Hospital of Guangzhou University of Chinese Medicine and 1 patient at Huadu District People's Hospital of Guangzhou from March to October 2025 were collected. There were 7 males and 5 females, aged 62 (range, 49-75)years. The surgical method was laparoscopic total gastrectomy, and the lymph node dissection method was D₂ lymphadenec-tomy combined with page‑turning splenic hilum lymph node dissection. Observation indicators: (1) surgical conditions; (2) surgical complications; (3) follow‑up. Measurement data with normal distribution were expressed as Mean±SD, and measurement data with skewed distribution were expressed as M (range). Count data were expressed absolute numbers.

Results (1) Surgical conditions: all 12 patients underwent surgery successfully. The operation time was (181±15) minutes, the splenic hilar lymphadenectomy time was (26.0±2.3) minutes, the volume of intraoperative blood loss was (48±12) mL, the number of lymph node harvest was 46.7 (range, 32.0-60.0) with 9 patients with positive lymph node metastasis, the number of splenic hilar lymph node dissected was 5.1±1.6 with 3 patients with positive splenic hilar lymph node metastasis, time to postoperative first flatus was (2.0±0.6) days, duration of postoperative hospital stay was (8.3±1.2) days. (2) Surgical complica-tions: of the 12 patients, no main splenic vascular injury occurred during the operation, and no secondary splenic portal bleeding, splenic infarction, or splenic abscess occurred after the operation. One patient developed a grade B pancreatic fistula after surgery. (3) Follow‑up: all 12 patients were followed up for 5.4 (range, 1.0-8.0) months. During the follow‑up period, all 12 patients had no local tumor recurrence or distant metastasis, and no postoperative complications such as delayed bleeding, anastomotic fistula, pancreatic fistula, or anastomotic stenosis occurred. Patients who developed grade B pancreatic fistula during hospitalization had no discomfort such as fever or abdominal pain after discharge.

Conclusion The page‑turning splenic hilum lymph node dissection technique can be safely used in laparoscopic total gastrectomy with D₂ lymphadenectomy.