Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 7/2015

01-07-2015

Technical feasibility of laparoscopic total gastrectomy with splenectomy for gastric cancer: clinical short-term and long-term outcomes

Published in: Surgical Endoscopy | Issue 7/2015

Login to get access

Abstract

Background

Since its widespread acceptance for the treatment of early gastric cancer, laparoscopic gastrectomy has been gaining popularity as a treatment option for advanced gastric cancer. However, laparoscopic total gastrectomy (LTG) with splenectomy is seldom performed, because of its difficulty of removal of station 10 lymph nodes; splenectomy is technically essential for complete removal of these lymph nodes. The purpose of this study was to describe the details of the LTG procedure and to evaluate the short- and long-term outcomes of LTG with splenectomy.

Methods

Of 725 consecutive patients with gastric cancer who underwent laparoscopic gastrectomy with lymph node dissection in our institution from January 1996 to December 2012, 18 consecutive patients who underwent LTG with splenectomy were enrolled in this study.

Results

No operative mortality occurred, and the pathological margins were free from cancer cells in all patients. The mean operation time was 388 min (range 324–566 min). The mean volume of blood loss was 45 ml (range 5–347 ml), and the mean number of dissected lymph nodes was 51 (range 40–105). Postoperative morbidity occurred in six patients (33.3 %) (each with grade B postoperative pancreatic fistula, postoperative bleeding, chylous ascites, atelectasis, ileus, and intra-abdominal infection). Five patients (27.8 %) developed recurrence (four in the peritoneum and one in the liver), and the overall 3- and 5-year survival rates were 83.0 and 72.6 %, respectively.

Conclusions

Considering the 0 % mortality rate and low rates of postoperative morbidity and locoregional recurrence, LTG with splenectomy is technically and oncologically acceptable. This procedure can be expanded to include advanced gastric cancer, which generally requires splenectomy for lymph node dissection.
Literature
1.
Kitano S, Iso Y, Moriyama M et al (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4(146–14):8
2.
Shimizu S, Uchiyama A, Mizumoto K et al (2000) Laparoscopically assisted distal gastrectomy for early gastric cancer: is it superior to open surgery? Surg Endosc 14:27–31PubMedCrossRef
3.
Noshiro H, Shimizu S, Nagai E et al (2003) Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients of heavier weight? Ann Surg 238:680–685PubMedCentralPubMedCrossRef
4.
Kitano S, Shiraishi N, Uyama I et al (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245(68–7):2
5.
Huscher CG, Mingoli A, Sgarzini G et al (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241(232–23):7
6.
Hwang SI, Kim HO, Yoo CH et al (2009) Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc 23(1252–125):8
7.
Satoh S, Okabe H, Kondo K et al (2009) Video. A novel laparoscopic approach for safe and simplified suprapancreatic lymph node dissection of gastric cancer. Surg Endosc 23:436–437PubMedCrossRef
8.
Tokunaga M, Hiki N, Fukunaga T et al (2009) Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection following standardization—a preliminary study. J Gastrointest Surg 13:1058–1063PubMedCrossRef
9.
Kanaya S, Haruta S, Kawamura Y et al (2011) Video: laparoscopy distinctive technique for suprapancreatic lymph node dissection: medial approach for laparoscopic gastric cancer surgery. Surg Endosc 25:3928–3929PubMedCrossRef
10.
Lee JH, Ahn SH, Park do J et al (2012) Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer. World J Surg 36:2394–2399PubMedCrossRef
11.
Shinohara T, Kanaya S, Taniguchi K et al (2009) Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg 144:1138–1142PubMedCrossRef
12.
Japanese Gastric Cancer Association (2010) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011(14):113–123
13.
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRef
14.
Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRef
15.
Goto H, Tokunaga M, Sugisawa N et al (2013) Value of splenectomy in patients with Siewert type II adenocarcinoma of the esophagogastric junction. Gastric Cancer 16(590–59):5
16.
Sano T, Sasako M, Katai H et al (1997) Amylase concentration of drainage fluid after total gastrectomy. Br J Surg 84(1310–131):2
17.
Maruyama K, Sasako M, Kinoshita T et al (1995) Pancreas-preserving total gastrectomy for proximal gastric cancer. World J Surg 19(532–53):6
18.
Nobuoka D, Gotohda N, Konishi M et al (2008) Prevention of postoperative pancreatic fistula after total gastrectomy. World J Surg 32(2261–226):6
19.
Kunisaki C, Makino H, Suwa H et al (2007) Impact of splenectomy in patients with gastric adenocarcinoma of the cardia. J Gastrointest Surg 11(1039–104):4
20.
Otsuji E, Yamaguchi T, Sawai K et al (1996) End results of simultaneous splenectomy in patients undergoing total gastrectomy for gastric carcinoma. Surgery 120(40–4):4
21.
Obama K, Okabe H, Hosogi H et al (2011) Feasibility of laparoscopic gastrectomy with radical lymph node dissection for gastric cancer: from a viewpoint of pancreas-related complications. Surgery 149(15–2):1
22.
Sano T, Sasako M, Yamamoto S et al (2004) Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study 9501. J Clin Oncol 22:2767–2773PubMedCrossRef
23.
Miki Y, Tokunaga M, Bando E et al (2011) Evaluation of postoperative pancreatic fistula after total gastrectomy with D2 lymphadenectomy by ISGPF classification. J Gastrointest Surg 15:1969–1976PubMedCrossRef
Metadata
Title
Technical feasibility of laparoscopic total gastrectomy with splenectomy for gastric cancer: clinical short-term and long-term outcomes
Publication date
01-07-2015
Published in
Surgical Endoscopy / Issue 7/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3870-6

Other articles of this Issue 7/2015

Surgical Endoscopy 7/2015 Go to the issue

OriginalPaper

Factors affecting the surgical approach and timing of bilateral adrenalectomy

Erratum

Erratum to: Tacks, staples, or suture: method of peritoneal closure in laparoscopic transabdominal preperitoneal inguinal hernia repair effects early quality of life

OriginalPaper

Bariatric postoperative fistula: a life-saving endoscopic procedure

OriginalPaper

Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety

OriginalPaper

Transthoracic approach is associated with increased incidence of atrial fibrillation after esophageal resection

Review

Non-vascular experimental and clinical applications of advanced bipolar radiofrequency thermofusion technology in the thorax and abdomen: a systematic review