Results of subtotal gastrectomy with complete dissection of the N2 lymph nodes preserving the spleen and pancreas in surgery for gastric cancer.

In radical resection for gastric cancer, dissection of the N2 lymph nodes is recommended, and total gastrectomy with splenectomy and distal pancreatectomy is sometimes necessary, even if the cancer is located in the middle part of the stomach. However, splenectomy affects the immunological status, and distal pancreatectomy induces diabetes mellitus. In 22 patients with macroscopic Stage II gastric cancer located in the middle part of the corpus, we performed a complete N2 lymph node dissection without splenectomy or pancreatectomy and preserving the short and splenic vessels. Of the 22 cases, 6 had early gastric cancer and 16 advanced cancer. Twenty cases underwent subtotal gastrectomy and 2 cases total gastrectomy. The average number of lymph nodes dissected was 39 (13-82), and 8 patients (36%) showed positive lymph node metastasis (N1(+) 2 cases, N2(+) 6 cases). Postoperative complications were observed in 4 patients (18%), one of whom died of an intraabdominal abscess; the others are alive with no recurrence. This operation is safe and rational, and is recommended mainly in patients with mid-stage gastric cancer located in the middle part of the corpus.