Hand-assisted Laparoscopic Spleen-preserving Total Gastrectomy for Gastric Cancer: Technical Feasibility and Early Results

To evaluate the feasibility and safety of hand-assisted laparoscopic spleen-preserving total gastrectomy for gastric cancer, we compared the operative outcomes between two methods for dissection of lymph nodes along the distal splenic artery (No. 11d) and at the splenic hilum (No. 10). Sixty-four patients with proximal or total gastric cancer operated on in our department from October 2009 to February 2012 were divided into two groups: the extracorporeal method group (EMG) and the intracorporeal method group (IMG). Operative time, estimated blood loss, number of lymph node retrieval, times of analgesic injection, time to the first flatus, and postoperative hospital stay were compared between the two groups. Estimated blood loss, times of analgesic injection, time to the first flatus, and postoperative hospital stay were equivalent between the two groups. The operative time was significantly shorter in the IMG than the EMG. There were no significant differences in tumor size, retrieved lymph nodes, American Joint Committee on Cancer/Union for International Cancer Control staging, or resection margins between the two groups. Hand-assisted laparoscopic spleen-preserving total gastrectomy is technically feasible and safe and allows for adequate lymphadenectomy.