Laparoscopic pancreas- and spleen-preserving D2 lymph node dissection in advanced (cT2) upper-third gastric cancer

Background and Objectives: Although the laparoscopic assisted total gastrectomy (LATG) has been performed in upper gastric cancer, dissection of lymph nodes No. 10 and 11d without resection of the distal pancreas and the spleen has been hard to accomplish, because of the possibilities of injury to splenic vessels and parenchyma of the spleen or pancreas. Herein, we present successful results in laparoscopic pancreas- and spleen-preserving D2 lymph node dissection in advanced upper gastric cancer. Methods: Between March 2004 and May 2007, 18 clinical T2 patients who underwent LATG with D2 lymph node dissection for upper gastric cancer were enrolled. Results: We used the technique of encircling and pulling the splenic artery with umbilical tape and that helped us complete dissection of lymph nodes No. 10 and 11d without distal pancreatectomy or splenectomy. The mean operative time was 370 min without any perioperative complications or conversion to an open procedure. Conclusions: Laparoscopic extended lymph node dissection without pancreatectomy or splenectomy can be adapted to the patients with clinical T2 upper gastric cancer. The techniques like taping of the splenic artery can be a useful tip for surgeons who wish to perform laparoscopic complete D2 lymph node dissection in advanced upper gastric cancer.