Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2015; 21(27): 8389-8397
Published online Jul 21, 2015. doi: 10.3748/wjg.v21.i27.8389
Anatomy and influence of the splenic artery in laparoscopic spleen-preserving splenic lymphadenectomy
Chao-Hui Zheng, Mu Xu, Chang-Ming Huang, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin
Chao-Hui Zheng, Mu Xu, Chang-Ming Huang, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: Zheng CH, Xu M and Huang CM designed the research; Li P, Xie JW and Wang JB performed the research; Lin JX, Lu J and Chen QY contributed to the diagnostic imaging work; Cao LL and Lin M analyzed the data; Zheng CH, Xu M and Huang CM wrote the paper.
Supported by National Key Clinical Specialty Discipline Construction Program of China, No. [2012]649; and Key Project of Science and Technology Plan of Fujian Province, China, No. 2014Y0025.
Institutional review board statement: Ethics committee of Fujian Union Hospital approved this retrospective study. Written consent was given by the patients for their information to be stored in the hospital database and used for research.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at hcmlr2002@163.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chang-Ming Huang, Professor, Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001 Fujian Province, China. hcmlr2002@163.com
Telephone: +86-591-83363366 Fax: +86-591-83320319
Received: February 11, 2015
Peer-review started: February 11, 2015
First decision: March 10, 2015
Revised: March 31, 2015
Accepted: April 17, 2015
Article in press: April 17, 2015
Published online: July 21, 2015
Processing time: 161 Days and 13.4 Hours
Abstract

AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery (SpA) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy (LTGSPL).

METHODS: The clinical anatomy data of 317 patients with upper- or middle-third gastric cancer who underwent LTGSPL in our hospital from January 2011 to December 2013 were collected. The patients were divided into two groups (concentrated group vs distributed group) according to the distance between the splenic artery’s furcation and the splenic hilar region. Then, the anatomical layout, clinicopathologic characteristics, intraoperative variables, and postoperative variables were compared between the two groups.

RESULTS: There were 205 patients with a concentrated type (64.7%) and 112 patients with a distributed type (35.3%) SpA. There were 22 patients (6.9%) with a single branch of the splenic lobar vessels, 250 (78.9%) with 2 branches, 43 (13.6%) with 3 branches, and 2 patients (0.6%) with multiple branches. Eighty seven patients (27.4%) had type I splenic artery trunk, 211 (66.6%) had type II, 13 (4.1%) had type III, and 6 (1.9%) had type IV. The mean splenic hilar lymphadenectomy time (23.15 ± 8.02 vs 26.21 ± 8.84 min; P = 0.002), mean blood loss resulting from splenic hilar lymphadenectomy (14.78 ± 11.09 vs 17.37 ± 10.62 mL; P = 0.044), and number of vascular clamps used at the splenic hilum (9.64 ± 2.88 vs 10.40 ± 3.57; P = 0.040) were significantly lower in the concentrated group than in the distributed group. However, the mean total surgical time, mean total blood loss, and the mean number of harvested splenic hilar lymph nodes were similar in both groups (P > 0.05 for each comparison). There were also no significant differences in clinicopathological and postoperative characteristics between the groups (P > 0.05).

CONCLUSION: It is of value for surgeons to know the splenic hilar vascular anatomy when performing LTGSPL. Patients with concentrated type SpA may be optimal patients for training new surgeons.

Keywords: Stomach neoplasms; Spleen-preservation; Laparoscopy; Lymphadenectomy; Vascular anatomy

Core tip: Japanese Gastric Cancer Association guidelines recommend splenic hilar lymphadenectomy in patients with upper- and middle-third gastric cancer. However, the vessels in the splenic hilum are intricate and variable. The areas adjacent to the splenic hilum are located in a deep, narrow operating space, which makes it difficult to identify the proper vessels and successfully complete splenic regional lymphadenectomy. Therefore, familiarity with the vascular anatomy is useful for surgeons performing laparoscopic total gastrectomy with spleen-preserving splenic hilar lymphadenectomy (LTGSPL) and may reduce the complications. This is the first study to investigate the splenic vascular anatomy in vivo and its influence on LTGSPL.