Difficulties and disputes of laparoscopic spleen-preserving splenic hilar lymph node dissection for advanced upper gastric cancer

Splenic hilar lymph node must be dissected in D₂ dissection for advanced upper gastric cancer. With the advances of surgical technology and updated treatment concept, spleen-preserving splenic hilar lymph node dissection has been widely accepted and gradually carried out by surgeons. However, laparoscopic spleen-preserving splenic hilar lymph node dissection has become a technical difficulty of laparoscopic surgery for gastric cancer due to complex anatomy of splenic hilar vessels and exposed difficulty in splenic hilar region, especially in obese patients. Surgeons not only have skillful laparoscopic techniques but also know anatomic characteristics of splenic hilar vascular well, and reasonable surgical approach and programmed surgical procedures can guarantee successful laparoscopic spleen-preserving splenic hilar lymph node dissection. Meanwhile, with the development of laparoscopic spleen-preserving splenic hilar lymph node dissection, there is also some disputes about lymph node dissection.