Skip to main content

Advertisement

Log in

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

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kitano S, Iso Y, Moriyama M et al (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4(146–14):8

    Google Scholar 

  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 14:27–31

    Article  CAS  PubMed  Google Scholar 

  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 238:680–685

    Article  PubMed Central  PubMed  Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

  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 23:436–437

    Article  PubMed  Google Scholar 

  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 13:1058–1063

    Article  PubMed  Google Scholar 

  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 25:3928–3929

    Article  PubMed  Google Scholar 

  10. Lee JH, Ahn SH, Park do J et al (2012) Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer. World J Surg 36:2394–2399

    Article  PubMed  Google Scholar 

  11. Shinohara T, Kanaya S, Taniguchi K et al (2009) Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg 144:1138–1142

    Article  PubMed  Google Scholar 

  12. Japanese Gastric Cancer Association (2010) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011(14):113–123

    Google Scholar 

  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 240:205–213

    Article  PubMed Central  PubMed  Google Scholar 

  14. Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

  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 22:2767–2773

    Article  PubMed  Google Scholar 

  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 15:1969–1976

    Article  PubMed  Google Scholar 

Download references

Disclosures

Drs. Nakata, Nagai, Ohuchida, Shimizu, and Tanaka have no conflicts of interest of financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eishi Nagai.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakata, K., Nagai, E., Ohuchida, K. et al. Technical feasibility of laparoscopic total gastrectomy with splenectomy for gastric cancer: clinical short-term and long-term outcomes. Surg Endosc 29, 1817–1822 (2015). https://doi.org/10.1007/s00464-014-3870-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3870-6

Keywords

Navigation