Skip to main content

Advertisement

SpringerLink
Log in

A preoperatively predictive difficulty scoring system for laparoscopic spleen-preserving splenic hilar lymph node dissection for gastric cancer: experience from a large-scale single center

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this study was to evaluate the risk factors that influence the difficulty of performing laparoscopic spleen-preserving splenic hilar lymph node dissection (SHLND) for gastric cancer and to establish a simple and effective scoring system to predict the surgical difficulty preoperatively.

Methods

Between January 2011 and December 2013, we prospectively collected and retrospectively analyzed the medical records of 317 patients with upper- or middle-third gastric cancer who underwent laparoscopic spleen-preserving SHLND. Univariate and multivariate analyses were performed to determine the independent predictors for surgical difficulty based on the operation time during spleen-preserving SHLND. A logistic regression model was used to identify determinant variables and construct a predictive difficulty scoring system.

Results

Multivariate analysis showed that gender, body mass index (BMI), number of splenic lobar arteries (SLAs), and type of SLA were independently predictive factors of operation time. According to these factors, we developed a predictive surgical difficulty scoring system and the difficulty levels are divided into 0, 1, 2, 3, and 4 points or more. Based on the relative risk, we stratified the surgical difficulty into the following three divisions: 0 low difficulty, 1–2 intermediate difficulty, and 3 points or more high difficulty. The patients with long operation time accounted for 19.6, 43.6, and 90.9 % for the three groups, respectively (p < 0.001). The area under the receiver operating characteristic curve for the logistic regression model and the simplified difficulty scoring prediction model was 0.717 and 0.715, respectively.

Conclusions

Based on four independent risk factors, including gender, BMI, number of SLAs, and type of SLA, we developed a simple and effective scoring system to predict the difficulty of laparoscopic spleen-preserving SHLND preoperatively. This novel scoring system might aid surgeons with different experience in performing operations at different levels of difficulty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, Inaba K, Yanaga K, Uyama I (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27:286–294

    Article  PubMed  Google Scholar 

  2. Kunisaki C, Makino H, Kosaka T, Oshima T, Fujii S, Takagawa R, Kimura J, Ono HA, Akiyama H, Taguri M, Morita S, Endo I (2012) Surgical outcomes of laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a case-control study. Surg Endosc 26:804–810

    Article  PubMed  Google Scholar 

  3. Kelly KJ, Selby L, Chou JF, Dukleska K, Capanu M, Coit DG, Brennan MF, Strong VE (2015) Laparoscopic versus open gastrectomy for gastric adenocarcinoma in the west: a case-control study. Ann Surg Oncol 22:3590–3596

    Article  PubMed  Google Scholar 

  4. Lin JX, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M (2015) Surgical outcomes of 2041 consecutive laparoscopic gastrectomy procedures for gastric cancer: a large-scale case control study. PLoS One 10:e0114948

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sato H, Shimada M, Kurita N, Iwata T, Nishioka M, Morimoto S, Yoshikawa K, Miyatani T, Goto M, Kashihara H, Takasu C (2012) Comparison of long-term prognosis of laparoscopy-assisted gastrectomy and conventional open gastrectomy with special reference to D2 lymph node dissection. Surg Endosc 26:2240–2246

    Article  PubMed  Google Scholar 

  6. Lee JH, Lee CM, Son SY, Ahn SH, Park do J, Kim HH (2014) Laparoscopic versus open gastrectomy for gastric cancer: long-term oncologic results. Surgery 155:154–164

    Article  PubMed  Google Scholar 

  7. Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Song KY, Ryu SY (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol 32:627–633

    Article  PubMed  Google Scholar 

  8. Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver.3). Gastric Cancer 14:101–112

    Article  Google Scholar 

  9. Schwarz RE (2002) Spleen-preserving splenic hilar lymphadenectomy at the time of gastrectomy for cancer: technical feasibility and early results. J Surg Oncol 79:73–76

    Article  PubMed  Google Scholar 

  10. Zhang CH, Zhan WH, He YL, Chen CQ, Huang MJ, Cai SR (2007) Spleen preservation in radical surgery for gastric cardia cancer. Ann Surg Oncol 14:1312–1319

    Article  PubMed  Google Scholar 

  11. Hyung WJ, Lim JS, Song J, Choi SH, Noh SH (2008) Laparoscopic spleen- preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer. J Am Coll Surg 207:e6–e11

    Article  PubMed  Google Scholar 

  12. Hur H, Jeon HM, Kim W (2008) Laparoscopic pancreas- and spleen-preserving D2 lymph node dissection in advanced (cT2) upper-third gastric cancer. J Surg Oncol l97:169–172

    Article  Google Scholar 

  13. Okabe H, Obama K, Kan T, Tanaka E, Itami A, Sakai Y (2010) Medial approach for laparoscopic total gastrectomy with splenic lymph node dissection. J Am Coll Surg 211:e1–e6

    Article  PubMed  Google Scholar 

  14. Li P, Huang CM, Zheng CH, Xie JW, Wang JB, Lin JX, Lu J, Wang Y, Chen QY (2014) Laparoscopic spleen-preserving splenic hilar lymphadenectomy in 108 consecutive patients with upper gastric cancer. World J Gastroenterol 20:11376–11383

    Article  PubMed  PubMed Central  Google Scholar 

  15. Washington K (2010) 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 17:3077–3079

    Article  PubMed  Google Scholar 

  16. Liu DL, Xia S, Xu W, Ye Q, Gao Y, Qian J (1996) Anatomy of vasculature of 850 spleen specimens and its application in partial splenectomy. Surgery 119:27–33

    Article  CAS  PubMed  Google Scholar 

  17. Pandey SK, Bhattacharya S, Mishra RN, Shukla VK (2004) Anatomical variations of the splenic artery and its clinical implications. Clin Anat 17:497–502

    Article  CAS  PubMed  Google Scholar 

  18. Michels NA (1942) The variational anatomy of the spleen and splenic artery. Am J Anat 70:21–72

    Article  Google Scholar 

  19. WHO (2000) International Obesity Task Force: The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications, Melbourne

    Google Scholar 

  20. Huang CM, Chen QY, Lin JX, Zheng CH, Li P, Xie JW (2014) Huang’s three-step maneuver for laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer. Chin J Cancer Res 26:208–210

    PubMed  PubMed Central  Google Scholar 

  21. Huang CM, Chen QY, Lin JX, Zheng CH, Li P, Xie JW, Wang JB, Lu J, Yang XT (2014) Laparoscopic spleen-preserving no. 10 lymph node dissection for advanced proximal gastric cancer using a left approach. Ann Surg Oncol 21:2051

    Article  CAS  PubMed  Google Scholar 

  22. Huang CM, Zheng CH, Li P, Xie JW (2015) Laparoscopic gastrectomy for gastric cancer: surgical technique and lymphadenectomy. Springer, Netherlands

    Book  Google Scholar 

  23. Brunschwig A (1948) Pancreato-total gastrectomy and splenectomy for advanced carcinoma of the stomach. Cancer 1:427–430

    Article  CAS  PubMed  Google Scholar 

  24. Takeuchi K, Tsuzuki Y, Ando T, Sekihara M, Hara T, Yoshikawa M, Ohno Y, Kuwano H (2001) Total gastrectomy with distal pancreatectomy and splenectomy for advanced gastric cancer. J Surg Res 101:196–201

    Article  CAS  PubMed  Google Scholar 

  25. Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H, Okajima K (1995) Pancreas-preserving total gastrectomy for proximal gastric cancer. World J Surg 19:532–536

    Article  CAS  PubMed  Google Scholar 

  26. Ikeguchi M, Kaibara N (2004) Lymph node metastasis at the splenic hilum in proximal gastric cancer. Am Surg 70:645–648

    PubMed  Google Scholar 

  27. Weitz J, Jaques DP, Brennan M, Karpeh M (2004) Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer. Ann Surg Oncol 11:682–689

    Article  PubMed  Google Scholar 

  28. Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, Welvaart K, van Krieken JH, Meijer S, Plukker JT, van Elk PJ, ObertopH Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H, Sasako M (2004) Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 22:2069–2077

    Article  CAS  PubMed  Google Scholar 

  29. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van Elk P, Obertop H, Gouma DJ, Taat CW (1995) Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345:745–748

    Article  CAS  PubMed  Google Scholar 

  30. Csendes A, Burdiles P, Rojas J, Braghetto I, Diaz JC, Maluenda F (2002) A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma. Surgery 131:401–407

    Article  PubMed  Google Scholar 

  31. Lee KY, Noh SH, Hyung WJ, Lee JH, Lah KH, Choi SH, Min JS (2001) Impact of splenectomy for lymph node dissection on long-term surgical outcome in gastric cancer. Ann Surg Oncol 8:402–406

    Article  PubMed  Google Scholar 

  32. Yu W, Choi GS, Chung HY (2006) Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 93:559–563

    Article  CAS  PubMed  Google Scholar 

  33. Aoyagi K, Kouhuji K, Miyagi M, Imaizumi T, Kizaki J, Shirouzu K (2010) Prognosis of metastatic splenic hilum lymph node in patients with gastric cancer after total gastrectomy and splenectomy. World J Hepatol 2:81–86

    PubMed  PubMed Central  Google Scholar 

  34. Oh SJ, Hyung WJ, Li C, Song J, Kang W, Rha SY, Chung HC, Choi SH, Noh SH (2009) The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer. J Surg Oncol l99:275–280

    Article  Google Scholar 

  35. Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y, Ueno M, Miyata S, Yamaguchi T (2009) Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery 146:483–489

    Article  PubMed  Google Scholar 

  36. Ogiso S, Yamaguchi T, Hata H, Fukuda M, Ikai I, Yamato T, Sakai Y (2011) Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication. Surg Endosc 25:1907–1912

    Article  PubMed  Google Scholar 

  37. Hyung WJ, Song C, Cheong JH, Choi SH, Noh SH (2007) Factors influencing operation time of laparoscopy-assisted distal subtotal gastrectomy: analysis of consecutive 100 initial cases. Eur J Surg Oncol 33:314–319

    Article  CAS  PubMed  Google Scholar 

  38. Kunisaki C, Makino H, Takagawa R, Sato K, Kawamata M, Kanazawa A, Yamamoto N, Nagano Y, Fujii S, Ono HA, Akiyama H, Shimada H (2009) Predictive factors for surgical complications of laparoscopy-assisted distal gastrectomy for gastric cancer. Surg Endosc 23:2085–2093

    Article  PubMed  Google Scholar 

  39. Yüney E, Höbek A, Keskin M, Yilmaz O, Kamali S, Oktay C, Bender O (2005) Laparoscopic splenectomy and LigaSure. Surg Laparosc Endosc Percutan Tech 15:212–215

    Article  PubMed  Google Scholar 

  40. de la Villeon B, Zarzavadjian Le Bian A, Vuarnesson H, Munoz Bongrand N, Halimi B, Sarfati E, Cattan P, Chirica M (2015) Laparoscopic partial splenectomy: a technical tip. Surg Endosc 29:94–99

    Article  PubMed  Google Scholar 

  41. Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21:745–753

    Article  PubMed  Google Scholar 

  42. Soltes M, Radoňak J (2014) A risk score to predict the difficulty of elective laparoscopic cholecystectomy. Videosurg Miniinvasive Tech 9(4):608–612

    Article  Google Scholar 

Download references

Acknowledgments

This study was funded by the National Key Clinical Specialty Discipline Construction program of China (No. [2012]649) and the Key Projects of Science and Technology Plan of Fujian Province (No. 2014Y0025). The authors are thankful to Fujian Medical University Union Hospital for hermanagement of our gastric cancer patient database.

Author information

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China

    Ping Li, Chang-Ming Huang, Jian-Xian Lin, Chao-Hui Zheng, Jian-Wei Xie, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu & Rui Fu Chen

Authors
  1. Ping Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chang-Ming Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jian-Xian Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chao-Hui Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jian-Wei Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jia-Bin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jun Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Qi-Yue Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Long-Long Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mi Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ru-Hong Tu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Rui Fu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chang-Ming Huang.

Ethics declarations

Disclosures

Drs. Ping Li, Chang-Ming Huang, Jian-Xian Lin, Chao-Hui Zheng, Jian-Wei Xie, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Rui Fu Chen have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, P., Huang, CM., Lin, JX. et al. A preoperatively predictive difficulty scoring system for laparoscopic spleen-preserving splenic hilar lymph node dissection for gastric cancer: experience from a large-scale single center. Surg Endosc 30, 4092–4101 (2016). https://doi.org/10.1007/s00464-015-4725-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4725-5

Keywords

Search

Navigation