[Spleen-preserving D2 lymphodissection in gastrectomy]

To analyze immediate and remote results of surgical treatment of 480 patients with gastric cancer who underwent total gastrectomy.

The study group included 371 patients who had spleen-preserving D2 lymphodissection during gastrectomy and control group consisted of 109 patients after D2 lymphodissection with splenectomy. Duration of surgery was 183.7±33.8 and 184.1±30.9 min in study and control groups respectively (p=0.72), blood loss - 330.2±33.7 and 351.8±28.8 ml (p=0.0001), incidence of postoperative complications - 6.7% (25 cases) and 4.6% (5 cases) respectively (p=0.5), mortality rate - 2.7% and 0.9% respectively (p=0.46). Number of excised regional lymph nodes of groups 10 and 11 was in most patients of the study group - 5.8 and 5.5 (p=0.92). Metastases in splenic hilus lymph nodes were diagnosed in 28 (7.5%) and 9 (8.2%) patients of the study and control groups respectively (p=0.30), metastases in lymph nodes along splenic vessels - in 24 (6.5%) and 7 (6.4%) patients respectively (p=0.90).

5-year survival in the study group was 40.3±3.0%, average life expectancy - 3.4±3.3 years, in the control groups - 33.1±5.6% and 2.7±2.5 years respectively. It was concluded that spleen-preserving D2 lymphodissection decreases incidence of postoperative complications and has similar drastic nature as standard lymphodissection with splenectomy.