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Is three-dimensional laparoscopic spleen preserving splenic hilar lymphadenectomy for gastric cancer better than that of two-dimensional? Analysis of a prospective clinical research study

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Abstract

Background

Three-dimensional (3D) systems for laparoscopy provide surgeons with additional information on spatial depth not found in two-dimensional (2D) systems.

Methods

This study enrolled 156 spleen-preserving splenic hilar lymphadenectomy (LSPSHL) patients in a randomized controlled trial (ClinicalTrials.gov Identifier NCT02327481) at the department of gastric surgery at Fujian Medical University Union Hospital between January 2015 and April 2016. The short-term efficacies were compared between the treatment groups. The unedited videos of 80 LSPSHL (40 procedures each for 3D and 2D) were rated for technical performance using the Generic Error Rating Tool.

Results

The data for 156 LSPSHL patients indicate that the estimated blood loss (EBL) (3D vs 2D = 66.3 vs. 99.0, P = 0.046) was significantly less in the 3D group. The postoperative recovery and complication rates were similar (P > 0.05). And there were no deaths within 30 days of surgery. Two observers analyzed 80 videos of LSPSHL. The results showed that there were fewer grasping-errors made in the 3D group than in the 2D group when dissecting the inferior pole region of spleen (IPRS) (P = 0.016) and the superior pole region of spleen (SPRS) (P = 0.022). Additionally, the inter-rater reliability was high regarding grasping-errors in the IPRS (intraclass correlation coefficient (ICC) 0.92) and in the SPRS (ICC 0.83). The ICC for the total number of errors was 0.82. The mean of errors in the 3D group (3D vs. 2D = 20.7 vs. 23.5, P = 0.022) was less than the 2D group.

Conclusions

Compared with 2D LSPSHL, 3D technology reduces EBL and technical errors during splenic hilar dissection.

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Acknowledgements

This work was supported by Scientific and Technological Innovation Joint Capital Projects of Fujian Province, China (No. 2016Y9031), the Construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171), the second batch of special support funds for Fujian Province Innovation and Entrepreneurship Talents (2016B013), the Youth Project of Fujian Provincial Health and Family Planning Commission (2016-1-41), the Nature Fund Health Joint Fund Project of Fujian Province (2015J01464), Fujian Province Medical Innovation Project (2015-CXB-16) and Chinese Physicians Association Young Physician Respiratory Research Fund.

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Author notes

  1. Zhi-Yu Liu and Qi-Yue Chen contributed equally to this work.

  2. Zhi-Yu Liu and Qi-Yue Chen should be considered co-first authors.

Authors and Affiliations

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

    Zhi-Yu Liu, Qi-Yue Chen, Qing Zhong, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ze-Ning Huang, Ju-Li Lin, Hua-Long Zheng, Chao-Hui Zheng, Chang-Ming Huang & Ping Li

  2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Zhi-Yu Liu, Qi-Yue Chen, Qing Zhong, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ze-Ning Huang, Ju-Li Lin, Hua-Long Zheng, Chao-Hui Zheng, Chang-Ming Huang & Ping Li

  3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China

    Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Chao-Hui Zheng, Chang-Ming Huang & Ping Li

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Corresponding authors

Correspondence to Chao-Hui Zheng, Chang-Ming Huang or Ping Li.

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Disclosures

Zhi-Yu Liu, Qi-Yue Chen, Qing Zhong, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ze-Ning Huang, Ju-Li Lin, Hua-Long Zheng, Chang-Ming Huang, Chao-Hui Zheng have no conflicts of interest or financial ties to disclose.

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464_2018_6640_MOESM1_ESM.tif

(A) Overall survival of spleen hilar lymphadenectomy (n = 156). (B) Recurrence-free survival of spleen hilar lymphadenectomy (n = 156). (TIF 408 KB)

Supplementary material 2 (DOC 32 KB)

Supplementary material 3 (DOC 57 KB)

Supplementary material 4 (DOC 18 KB)

464_2018_6640_MOESM5_ESM.tif

No difference in the D2 lymphadenectomy noncompliance rate was demonstrated among these subgroups (A: Noncompliance rate of nodal dissection (pT), PpT1=0.380, PpT2 = 0.101, PpT3 = 1, PpT4 = 0.752, PTotal = 0.831). (B: Noncompliance rate of nodal dissection (pN), PN0 = 0.853, PN1 = 0.675, PN2 = 0.398, PN3 = 0.051, PTotal = 0.831). (C: Noncompliance rate of nodal dissection (pTNM stage), PI = 1, PII = 0.711, PIII = 0.348, PTotal = 0.831). (D: Noncompliance rate of nodal dissection (BMI), PBMI<18 =1, P18≤BMI<25 =0.713, PBMI≥25 =0.705, PTotal = 0.831). (TIF 4810 KB)

Mean number of retrieved lymph nodes. (TIF 1710 KB)

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Liu, ZY., Chen, QY., Zhong, Q. et al. Is three-dimensional laparoscopic spleen preserving splenic hilar lymphadenectomy for gastric cancer better than that of two-dimensional? Analysis of a prospective clinical research study. Surg Endosc 33, 3425–3435 (2019). https://doi.org/10.1007/s00464-018-06640-7

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