Laparoscopic spleen-preserving complete splenic hilum lymphadenectomy for advanced proximal gastric cancer

For advanced proximal gastric cancer, total gastrectomy with D2 lymphadenectomy is the standard surgical therapy containing splenic hilum lymph nodes (LNs) dissection. However, laparoscopic spleen-preserving complete splenic hilum LNs dissection for advanced proximal gastric cancer is technically challenging. Herein, we introduced an omnibearing method for laparoscopic spleen-preserving complete splenic hilar lymphadenectomy in racial total gastrectomy. The order of lymphadenectomy was No. 4d and 6 LNs-No. 12a, 8a, 9 and 7 LNs-No. 1, 3 and 5 LNs-No. 4sb, 4sa and 2 LNs-No. 10 and 11 (anterosuperior) LNs-No. 10 and 11 (posterior) LNs. During dissecting No. 10 and 11 LNs, we divided them into two parts, namely LNs anterosuperior and posterior to the splenic vessel. Laparoscopic total gastrectomy with spleen-preserving splenic hilum LNs dissection using an omnibearing method for advanced proximal gastric cancer was safe and technically feasible in experienced hands. Further studies in terms of its clinical significance are needed.