Basic Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2023; 15(5): 812-824
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.812
Distribution of splenic artery lymph nodes and splenic hilar lymph nodes
Yuya Umebayashi, Satoru Muro, Masanori Tokunaga, Toshifumi Saito, Yuya Sato, Toshiro Tanioka, Yusuke Kinugasa, Keiichi Akita
Yuya Umebayashi, Masanori Tokunaga, Toshifumi Saito, Yuya Sato, Toshiro Tanioka, Yusuke Kinugasa, Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
Satoru Muro, Keiichi Akita, Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
Author contributions: Umebayashi Y, Muro S, Tokunaga M, Saito T, Sato Y, Tanioka T, Kinugasa Y and Akita K designed and coordinated the study; Umebayashi Y, Muro S and Saito T acquired data; Umebayashi Y and Muro S analyzed data; Umebayashi Y, Muro S, Sato Y, Tokunaga M and Akita K interpreted the data; Umebayashi Y, Muro S, Tokunaga M and Akita K drafted the manuscript; all authors approved the final version of the article.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board at Tokyo Medical and Dental University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masanori Tokunaga, MD, PhD, Associate Professor, Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. tokunaga.srg1@tmd.ac.jp
Received: December 28, 2022
Peer-review started: December 28, 2022
First decision: February 4, 2023
Revised: February 18, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: May 27, 2023
Abstract
BACKGROUND

Total gastrectomy with splenectomy is the standard treatment for advanced proximal gastric cancer with greater-curvature invasion. As an alternative to splenectomy, laparoscopic spleen-preserving splenic hilar lymph node (LN) dissection (SPSHLD) has been developed. With SPSHLD, the posterior splenic hilar LNs are left behind.

AIM

To clarify the distribution of splenic hilar (No. 10) and splenic artery (No. 11p and 11d) LNs and to verify the possibility of omitting posterior LN dissection in laparoscopic SPSHLD from an anatomical standpoint.

METHODS

Hematoxylin & eosin-stained specimens were prepared from six cadavers, and the distribution of LN No. 10, 11p, and 11d was evaluated. In addition, heatmaps were constructed and three-dimensional reconstructions were created to visualize the LN distribution for qualitative evaluation.

RESULTS

There was little difference in the number of No. 10 LNs between the anterior and posterior sides. For LN No. 11p and 11d, the anterior LNs were more numerous than the posterior LNs in all cases. The number of posterior LNs increased toward the hilar side. Heatmaps and three-dimensional reconstructions showed that LN No. 11p was more abundant in the superficial area, while LN No. 11d and 10 were more abundant in the deep intervascular area.

CONCLUSION

The number of posterior LNs increased toward the hilum and was not neglectable. Thus, surgeons should consider that some posterior No. 10 and No. 11d LNs may remain after SPSHLD.

Keywords: Gastric cancer, Laparoscopic gastrectomy, Anatomy, Splenic hilar lymph node, Laparoscopic spleen-preserving splenic hilar lymph node dissection

Core Tip: Recently, laparoscopic spleen-preserving splenic hilar lymph node (LN) dissection (SPSHLD) has emerged as a viable alternative to splenectomy for advanced proximal gastric cancer with greater curvature invasion. However, laparoscopic SPSHLD has been observed to leave behind the posterior splenic hilar LNs. In this study, we aimed to clarify the distribution of splenic hilar and splenic artery LNs by examining cadavers, and to evaluate the possibility of omitting posterior LN dissection in laparoscopic SPSHLD from an anatomical perspective. Our findings revealed that the number of posterior LNs increased towards the hilum and was not negligible. Therefore, it is crucial for surgeons to consider that some posterior LNs may remain after SPSHLD.