Post hoc analysis: Laparoscopic spleen-preserving hilar lymphadenectomy may improve 5-year survival in advanced proximal gastric cancer without greater curvature invasion – JAMA Surg

This study presents the results of a post hoc secondary analysis from the Fuges-02 randomized clinical trial, investigating the effects of laparoscopic total gastrectomy (LTG) with and without spleen-preserving splenic hilar lymphadenectomy (LSPSHL) in 536 patients with resectable advanced proximal gastric cancer (APGC) lacking greater curvature invasion. Conducted from January 2015 to October 2018 with a minimum follow-up of five years, the study reported a significantly improved 5-year disease-free survival (DFS) rate of 63.9% in the LTG with LSPSHL group compared to 55.1% in the LTG alone group. The overall survival (OS) also favored the LSPSHL group at 66.2% versus 57.4% in the LTG group. Furthermore, the recurrence rate was lower in the LSPSHL group, with a notable reduction in recurrence at the No. 10 lymph node area, indicating a protective benefit from the addition of LSPSHL. The findings suggest a potential therapeutic advantage of incorporating LSPSHL in surgical protocols for APGC without greater curvature invasion, warranting further investigation through multicenter studies.

Reference (link to abstract – $ for full-text):

Jian-xian Lin et al. (2024). Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Greater Curvature Invasion. JAMA Surg, Published online May 1, 2024. doi:10.1001/jamasurg.2024.1023