| Objective: To investigate the short-term and long-term therapeutic effects of laparoscopic spleen-preserving D2 total gastrectomy(LSTG)on advanced upper-and middle-third gastric cancer(AUTGC).Methods: In this retrospective study,a total of eighty-five patients with advanced upper-and middle-third gastric adenocarcinoma were enrolled in generral surgery department of zhangzhou mumicipal hospital during January 2016 to March 2017.All the patients underwent laparoscopic radical gastrectomy.They were divided into two groups.One group had 35 cases receiving the laparoscopic spleen-preserving spleen hilar lymphnode dissection(shorten as dissection group),and the other group contained 50 cases without spleen hilar lymphnode dissection(shorten as non-dissection group).The safety,intraoperative complications,postoperative complications,number of No.10 lymph node(LN)dissections,metastasis rates,overall and disease-free survival rates were compared between the two groups.Results: The average amount of surgical bleeding was 62.4±7.8 ml in the dissection group compared to 55.4±6.3ml in non-dissection group.The mean time and the amount of bleeding during laparoscopic spleen-preserving spleen hilar lymphnode dissection was 25.31±1.91 min and 16.04±1.18 ml in the group of concentrated type Sp A,31.66 ± 2.12 min and 18.18± 1.35 ml in the group of distributed type Sp A.The incidence of total complications in the dissection group was 14%,which is higher than that in the non-dissection group(11.4%).Bigger difference was observed in the incidence of postoperative complications(14% in the dissection group vs 8% in the non-dissection group).The median follow-up time of the whole group was 26 months.The 3-year overall survival rates in the dissection group were significantly higher than that in the non-dissection group(66.4% vs 65.2%,p=0.047).The dissection group also had a significantly higher disease-free survival rates in contrast to the non-dissection group(65.8% vs 55.2%,p=0.024).Conclusion: Laparoscopic spleen-preserving spleen hilar lymphnode dissection is safe,as it does not increase the amount of surgical bleeding and postoperative complications.The postoperative recovery is also similar to that of the patients without spleen hilar lymphnode dissection.Compared to the patients possessing distribute or multi branches with concentrated or single type Sp A,the amount of bleeding and operation time increased in distributed type Sp A.Compared with patients without spleen hilar lymphnode dissection,laparoscopic spleen-preserving spleen hilar lymphnode dissection can improve the disease-free and overall survival rate of patients with advanced upper-and middle-gastric cancer. |
