[Resection of gastric carcinoma with preserving of the spleen and pancreas and functional clearance lymph nodes of the spleen hillus and splenic artery]

Abstract

Objective: To study the practical effects of the preserved spleen and pancreas and functional, clearance of lymph nodes of the spleen hillus and splenic artery for gastric carcinoma.

Methods: Spleen and pancreatic involvement was retrospectively reviewed in 439 cases of resectable carcinoma of the gastric cardia, gastric corpus and total stomach. During gastric operation, 2 ml methylene blue was injected into the subserosal space of the gastric cardia or corpus to observe the spreading of lymphatic flow of the stomach in 54 cases. The No10, No11 lymph node metastasis rates, postoperative complications and survival rates were observed in 63 case of gastric carcinoma that had received gastrectomy with preservation of the spleen and pancreas (PSP) and functional clearance of lymph nodes of the spleen hillus and splenic artery.

Results: Invasion of gastric cancer into the pancreas and spleen occurred in 5.7% (25/439) and 2.3% (10/439) respectively. Methylence blue was injected into the subserosal space of the stomach without diffusion into the spleen and pancreas. The No10, No11 lymph node metastasis rates of PSP, pancreas preservation (PR) and pancreas and spleen resection (PSR) were 17.5% (11/63), 19.1% (12/63); 20.8% (45/216), 25% (54/216); 20% (6/30), 23% (7/30), respectively (P > 0.05). The occurrence of postoperative complications and mortality was lower in patients with PSP than those with spleen and parts of pancreas resected, whereas the survival rate was higher in patients with PSP. The 5-year and 10-year survival rates of gastric carcinoma in stage II, III a were markedly improved in patients with PSP.

Conclusions: PSP for patients with gastric cancer is safe and functional resectable. The occurrence of postoperative complications is lower and the survival rates are higher in patients with PSP than those with spleen and part of pancreas resected. PSP is beneficial to those with gastric carcinoma in stage II, IIIa.