Laparoscopic Spleen-Preserving No. 10 Lymph Node Dissection for AGC

Inclusion Criteria:

• Patients age older than 18 years (including 18 years old);
• The primary lesion is located in the upper or middle third of the stomach, including Siewert II type and Siewert III type adenocarcinoma of the esophagogastric junction;
• Pathologically confirmed primary gastric adenocarcinoma by endoscopic biopsy (including papillary, tubular, mucinous, signet ring cell and poorly differentiated adenocarcinoma);
• Preoperative cancer stage cT2-4aN0-3M0 (according to AJCC-7th TNM staging);
• The Eastern Cooperative Oncology Group performance status of 0 or 1;
• The American Society of Anesthesiology classes of I, II or III;
• Signed Informed consent.

Exclusion Criteria:

• Pregnant or lactating women;
• Suffering from severe mental disorder;
• Previous gastrectomy, including endoscopic submucosal dissection and endoscopic mucosal resection;
• Integrated or enlarged lymph node with maximum diameter larger than 3 cm according to preoperative imaging, including significantly enlarged or bulky No. 10 lymph nodes;
• Siewert I type adenocarcinoma of the esophagogastric junction;
• Other malignant diseases (within 5 years);
• Other illnesses needed operation concurrently;
• Complications (bleeding, perforation or obstruction) required emergency surgery due to primary gastric malignancy;
• Pulmonary function tests FEV1 less than 50% of predicted value;
• Patient suffered from bleeding tendency disease such as hemophilia or took anti-coagulant medication due to deep vein thrombosis.
• Patients with obvious tumor infiltration in the spleen and splenic vessels which require splenectomy.