Laparoscopic Splenic Hilar Lymph Node Dissection is Recommended for Pathologic Stage IIIA Middle and Upper Gastric Cancer: A Comparative Study with Standard D2 Laparoscopic Distal Gastrectomy

Abstract Purpose D2 lymphadenectomy is considered a standard procedure for distal gastrectomy (DG). However, whether splenic hilar (No. 10) lymph node (LN) should be included in the extent of D2 lymphadenectomy for total gastrectomy (TG) is still controversial. Therefore, we assessed the survival benefit of laparoscopic No.10 LN dissection based on the comparison of long-term survival of patients undergoing laparoscopic TG (LTG) with laparoscopic No.10 LN dissection and laparoscopic DG (LDG). Methods The clinicopathological data of 2069 patients who underwent laparoscopic radical gastrectomy were retrospectively analyzed. The survival of the LDG group, the LTG with dissection of No. 10 LN (LTG+No. 10) group and the LTG without dissection of No. 10 LN (LTG-No. 10) group was compared. Results After adjusting for age, pT stage, pN stage and pTNM stage by 1:1:1 propensity score matching (PSM), there were 373 patients in each group. Kaplan-Meier (K-M) survival analysis showed that only in the pIIIA stage, the 5-year survival overall survival (OS) and cancer specific survival (CSS) of the LTG+No. 10 group was significantly better than that of the LTG-No. 10 group and comparable with that of the LDG group. Multivariate Cox regression analyses showed that dissection of No. 10 LN was an independent favorable factor for OS and CSS in all patients and patients with pIIIA. Conclusion In patients with stage pIIIA, those undergoing LTG with No. 10 LN dissection could achieve a long-term outcome comparable to that of patients at the same pathological stage undergoing LDG.