RESUMEN
Background: Surgery with total gastrectomy and D2 lymph node dissection (LND) has been recommended as the standard treatment for patients with advanced upper and middle gastric carcinoma and/or Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG). However, whether the No. 10 lymph node (No. 10 LN, also known as splenic hilar LN) should be dissected in total gastrectomy remains controversial. We aimed to evaluate whether the No. 10 LND with spleen preservation has survival benefit for patients with gastric cancer and/or AEG who underwent the total gastrectomy. Methods: The PubMed, Embase, the Cochrane Library, ClinicalTrials.gov and American Society of Clinical Oncology.org (ASCO.org) were electronically searched to identify eligible studies. The primary outcome was the survival rate, and secondary outcomes included the disease-free survival (DFS) rate and side effects. The Review Manager 5.3.5 software was used for the meta-analysis. The odds ratio (OR) and mean difference with 95% confidence interval (CI) were calculated. The statistical heterogeneity was assessed using chi-square (χ2) and I2 tests. Results: Eight studies enrolling a total of 4,131 patients were eligible for our review. The meta-analysis results demonstrated that the No. 10 LND group was significantly better than the non-No. 10 LND group in terms of the 3- (OR =0.71, 95% CI: 0.62-0.81, P<0.00001) and the 5-year (OR =0.66, 95% CI: 0.58-0.75, P<0.00001) survival rates but not in the 1-year survival rate (OR =0.91, 95% CI: 0.75-1.11, P=0.36). The DFS rates in the No. 10 LND group were significantly increased after 1 (OR =0.76, 95% CI: 0.61-0.93, P=0.008), 3 (OR =0.69, 95% CI: 0.60-0.81, P<0.00001), and 5 (OR =0.66, 95% CI: 0.56-0.76, P<0.00001) years compared with those in the non-No. 10 LND group. Discussion: Evidence shows that the No. 10 LND with spleen preservation can improve the survival and the DFS rates for patients with gastric cancer and/or Siewert type II/III AEG who underwent the total gastrectomy. High-quality prospective trials are expected.
RESUMEN
Laparoscopy splenectomy (LS) was adopted in surgery from 1980s, it has become the main way of exploring for treating spleen diseases. Compared with conventional open surgery, LS has been gradually accepted by physicians and patients due to its advantages, including minimal surgical injury, less intraoperative blood loss, quick postoperative recovery, shorter hospital period, better cosmetic result, less risk of postoperative infections and improved postoperative quality of life Here, we try to investigate the splenic pedicle transection by using Endo-GIA (a linear stapling device) procedure and manual manipulation of secondary splenic pedicle for LS. A retrospective study was conducted on 60 patients who underwent LS. And patients were divided into two groups. 30 patients (group A) received splenic pedicle transection with Endo-GIA procedure and in the other 30 patients (group B) underwent secondary splenic pedicle transection for LS. Perioperative outcome measures of each group were recorded, including operation duration, intraoperative blood loss, postoperative flatus pass time, postoperative complications, drainage duration, hospital cost and length of hospital stay. Surgeries were successfully achieved in 60 patients. The operative duration of group A was significantly shorter than that of group B. However, group B was significantly superior over Endo-GIA group in terms of the intraoperative blood loss, postoperative flatus pass time, drainage duration, length of hospital stay and total cost of hospital stays. No significant differences were observed in postoperative fever, ascites and hyperamylasemia between two groups. Both of these two approaches for LS are safe and feasible. However, compared with Endo-GIA procedure, manual manipulation of secondary splenic pedicle for LS may leading to less intraoperative blood loss, results in less hospital expense, and hence can be widely adopted in clinical practice.
