Total Gastrectomy With Dissection of Lymph Nodes Along the Splenic Artery: A Pancreas-Preserving Method

Furukawa, Hiroshi; Hiratsuka, Masahiro; Ishikawa, Osamu; Ikeda, Masataka; Imamura, Hiroshi; Masutani, Seizo; Tatsuta, Masayuki; Satomi, Takashi

doi:10.1007/s10434-000-0669-6

Cited by 47 publications

(32 citation statements)

References 15 publications

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“…The study by Okinaga et al [30] was comparatively much smaller, and again, no significant difference in overall survival with spleen preservation was demonstrated. Furukawa et al [27] also found no statistically significant increase in the reported fistula or leaks rate, and no difference in overall survival in patients Significance corresponds to the noted superscripts AL anastomotic leakage, N number, MNS mean survival, MS median survival, NR not reported, PF pancreatic fistula, PR pancreaticosplenectomy, pts patients, R0 resection with no residual tumor, SP spleen-preserving, SR splenectomy S94 S. S. Brar et al…”

Section: Discussionmentioning

confidence: 92%

“…In the retrospective studies, spleen preservation was associated with improved survival in 8 studies, diminished survival in 1 study, and no statistically significant difference in survival in 12 studies (Tables 3, 4, 5). In the one RCT comparing patients who underwent extended lymphadenectomy with or without pancreas preservation, there was no statistically significant difference in overall survival [27] (Table 1). …”

Section: Overall Survivalmentioning

confidence: 98%

“…1). Of these, 3 studies were RCTs comparing standard D2 lymphadenectomy with spleenpreserving D2 lymphadenectomy [26,28,30] (Table 1), 1 was an RCT comparing standard D2 lymphadenectomy with pancreas-preserving D2 lymphadenectomy [27] ( Table 1), 6 were prospective studies examining the extent of lymphadenectomy [1,2,9,10,34,35] (Table 2), and 32 were retrospective studies [7, 8, 11, 12, 14-19, 21-23, 29, 36-51] (Table 3). The four RCTs examining spleen and/or pancreas preservation were evaluated and given Jadad scores between 1 and 3 ( Table 1).…”

Section: Literature Searchmentioning

confidence: 99%

“…Preservation of the spleen and pancreas during D2 lymphadenectomy has been advocated by the authors of the DGCT-recommendations that were made on the basis of post-hoc subgroup analysis and must be interpreted accordingly [24]. Despite assertions from both trials that resection of the spleen and pancreas in the D2 arm was responsible for increased operative morbidity and mortality, no RCT has shown a survival advantage when performing pancreas-preserving or spleen-preserving D2 resection compared to the traditional D2 resection [26][27][28]. In addition, the role of the spleen in cancer immunology has been cited as a reason to consider spleen preservation during extended lymphadenectomy [12].…”

Section: Introductionmentioning

confidence: 99%

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A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

et al. 2011

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Background The overall prognosis and survival of patients with advanced gastric cancer are generally poor. Extended lymphadenectomy is recommended for patients with advanced gastric cancer; however, splenectomy and distal pancreatectomy performed with an extended lymph node dissection may be associated with increased morbidity and mortality. Method Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 31 December 2009. Studies on gastric carcinoma investigating extended lymphadenectomy with splenectomy and/or pancreaticosplenectomy that reported data on surgical outcomes or survival were selected. Results Forty studies were included in this review. Decreased complication rates were demonstrated with spleen preservation in two prospective studies and three retrospective studies, and with pancreas preservation in five retrospective studies. No randomized controlled trial showed survival benefit or detriment for preservation of spleen or pancreas in extended lymphadenectomy. Improved survival was demonstrated with spleen preservation in two prospective and eight retrospective studies, and with pancreas preservation in one prospective and four retrospective studies. Conclusions Preservation of the spleen and pancreas during extended lymphadenectomy for gastric cancer decreases complications with no clear evidence of improvement or detriment to overall survival.

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Section: Discussionmentioning

confidence: 92%

Section: Overall Survivalmentioning

confidence: 98%

Section: Literature Searchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

et al. 2011

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“…In these randomized trials from Chile [8], Korea [9], and Japan [10], researchers reported no survival benefit from splenectomy in patients with a total gastrectomy, whereas morbidity was increased. A meta-analysis of operative survival with the data from these randomized trials showed no statistically significant difference (OR, 1.59; 95 % CI, 0.44-5.79) [11].…”

mentioning

confidence: 99%

Should we remove splenic hilus lymph nodes for esophagogastric junction adenocarcinoma?

Hartgrink

2013

Gastric Cancer

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Postoperative pancreatic fistula after gastrectomy for gastric cancer

Washio

Yamashita

Hosoda

et al. 2020

Annals of Gastroent Surgery

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Postoperative pancreatic fistula is one of the most severe complications after gastric cancer surgery, and can cause critical patient conditions leading to surgery‐related death. Fortunately, the incidence of postoperative pancreatic fistula after gastrectomy seems to be decreasing with changes in operative procedures. The rate was reported at about 30% after open gastrectomy with Appleby's method in 1997, but lately has improved below 1% for robotic gastrectomy in 2019. For the diagnosis of postoperative pancreatic fistula, drain amylase concentration has been demonstrated to be beneficial and some reports have proposed the optimal cut‐off values of drain amylase to predict major postoperative pancreatic fistula. There have been many reports identifying risk factors for postoperative pancreatic fistula, including overweight patients, pancreatic anatomy, blunt trauma from compression of the pancreas, and thermal injuries caused by the continuous use of energy devices. And importantly, laparoscopic gastrectomy has been shown to be more often associated with postoperative pancreatic fistula than open gastrectomy in the prospective national clinical database in Japan. Hence, further sophistication of surgical techniques to reduce pancreas compression would have great promise in reducing postoperative pancreatic fistula after laparoscopic gastrectomy.

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Total Gastrectomy With Dissection of Lymph Nodes Along the Splenic Artery: A Pancreas-Preserving Method

Abstract: The pancreas-preserving method described here was superior to the more common pancreas resecting method with regard to surgical risk and postoperative glucose tolerance.

Cited by 47 publications

References 15 publications

A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

Should we remove splenic hilus lymph nodes for esophagogastric junction adenocarcinoma?

Postoperative pancreatic fistula after gastrectomy for gastric cancer

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