To study the safety and feasibility of retropancreatic approach for splenic hilar lymph node dissection in laparoscopic total gastrectomy.

The clinical data of 63 patients with gastric cancer who underwent laparoscopic total gastrectomy and splenic hilar lymph node dissection from January 2015 to December 2018 were retrospectively analyzed. They were divided into left approach group (33 cases) and retropancreatic approach group (30 cases). Statistical software SPSS 24.0 was used for data analysis. The measurement data of perioperative indexes and quality of life scores of the two groups were (±s), and the independent sample t-test was used for comparison between groups. The count data of postoperative complications were n(%). The χ² test was used for comparison between groups, and the rank sum test was used for classification of tumor stages. P<0.05 was the inspection standard.

The operation was successfully completed in all patients without conversion to splenectomy or conversion to laparotomy. The operation time of the retropancreatic approach group was shorter than that of the left approach group (P<0.05), while the bleeding volume of the left approach group was lower than that of the retropancreatic approach group (P<0.05). There was no significant difference in exhaust time, hospital stay and the number of splenic hilar lymph node (P>0.05). The incidence of complications in the left approach group was 18.2%, while that in the retropancreatic approach group was 20%, there was no significant difference between the two groups (P>0.05). There was no significant difference in the scores of QOL between the two groups at 6 months after operation (P>0.05).

Laparoscopic radical total gastrectomy and splenic hilar lymph node dissection via retropancreatic approachis safe and feasible with good anatomical structure and standard operation.