346Cases Analysis For Laparoscopic Spleen-preserving Splenic Hilar Lymph Node Dissection For Proximal Gastric Cancer

Objective: The aim of this study is to formulate a model that efficiently predictssplenic hilar lymph node metastasis (SHLNM) in patients with proximal gastriccancer (PGC) and to assess indications for laparoscopic spleen-preserving splenichilar lymph node dissection (LSPSHLND) based on this model.Methods Patients (N=346) with PGC who underwent LSPSHLND from January2010to October2013were prospectively enrolled and retrospectively evaluated.Groups of patients with and without SHLNM were compared, and independent riskfactors for SHLNM determined. Akaike’s information criterion (AIC) and the areaunder the ROC curve (AUC) were used to formulate the most efficient predictivemodel of SHLNM in patients with PGC.Results Of the346patients with PGC, only35(10.1%) were diagnosed with SHLNM.Depth of invasion, tumor location and metastases to No.7and No.11lymph nodes(LNs) were independent risk factors for SHLNM (p<0.0001each). A model involvingdepth of invasion, tumor location and metastasis to No.7and11LNs, yielded alowest AIC of-913.535and a highest AUC of0.897(95%CI:0.851-0.944).Stratification analysis showed no SHLNMs in the absence of serosal invasion of thelesser curvature and metastases at No.7and No.11LNs (T2-3:0/87,95%CI:0.00-4.15).Conclusions A model that included four factors (depth of invasion, tumor locationand metastases at No.7and No.11LNs) was found optimal for predicting SHLNM inpatients with PGC. LSPSHLND may be avoided when tumors on the lesser curvaturedid not show serosal invasion or metastases at No.7and No.11LNs.