Preliminary Outcomes Of Laparoscopic Spleen-preserving No.10 Lymph Node Dissection For Locally Advanced Upper Gastric Cancer

Objective: To evaluate the safety and feasibility of laparoscopic spleno-sparing No.10 lymph node dissection.Patients with locally advanced(T2-4a,N-/+,M0)upper gastric cancer were selected for study subjects.Methods: 37 patients with advanced upper gastric cancer who underwent laparoscopic radical gastrectomy and spleen preserving N0.10 lymph node dissection in our department from October 2016 to January 2019 were collected as the observation group.Thirty-six patients with advanced upper gastric cancer who underwent radical gastrectomy combined with splenectomy with No.10 lymph node dissection and who were collected from the external literature were selected as the control group.General data,intraoperative data,pathological data,postoperative complication data and postoperative rehabilitation data were compared between the two groups.Results: The average operation time of the two groups was 187.97±13.62 min and 217.34±32.71 min,respectively.The observation group was significantly shorter than the control group,and the difference was statistically significant.The splenic hilum lymph node dissection time was 20.37±2.84 min in the observation group and 23.58 ±4.26 min in the control group,and the difference was statistically significant(t=3.798,P <0.05).The average intraoperative blood loss in the observation group was significantly lower than that in the control group(57.84±20.57m1vs216.92±43.90,t=19.912,P<0.05).The number of lymph node dissections in the observation group and the control group was 37.58±8.21 and 29.31±6.34,respectively,and the difference was statistically significant.Observation group on grade?complication rates and overall incidence of complications was better than control group,and the difference is statistically significant(P<0.05).The observation group was superior to the control group in postoperative recovery indicators(postoperative bed rest days,first ventilation time,postoperative fasting days,drainage tube indwelling days,postoperative hospitalization days,total hospitalization days).Conclusion: It is necessary to perform splenic hilar lymph node dissection for the locally advanced upper gastric carcinoma;Under the premise of preserving the spleen,laparoscopic splenoscopic N0.10 lymph node dissection can completely remove the splenic hilum lymph nodes,with less surgical damage,lower overall postoperative complication rate and faster postoperative recovery.