Figure 1.
Schematic drawing of the fascias and the vascular anatomy around the splenic hilum.
a. The anatomic relationships between the APF, GSL and SRL, which are all derived from the DM. b. The anatomic relationships between the connected fascias around the splenic hilum. c. The anatomic relationships between the GSL, the SRL, the terminal branch of the splenic vessels and the SGVs. APF, Anterior pancreatic fascia; SRL: Splenorenal ligament; GSL, Gastrosplenicligament; TM, Transverse mesocolon; AG, Adrenal gland; SGVs,Short gastric vessels.
Figure 2.
a. The APF was completely lifted cephalad to fully expose the superior border of the pancreas and enter the retropancreatic space (RPS). b.The lower lobar vessels of the spleen (LLVSs) were exposed between the two layers of the SRL by following the RPS c. The left gastroepiploic vessels were exposed by following the fascias. d. Dissection of the No. 11d LN was performed by following the intrafascial space. APF: Anterior pancreatic fascia; SRL, Splenorenal ligament; LLVSs, Lower lobar vessels of spleen; GSL, Gastrosplenicligament; LGEVs, Left gastroepiploic vessels; SPA, Splenic artery.
Figure 3.
Dissection of the splenic hilar LNs was performed by following the perigastric fascias and the intrafascial space.
a. The upper lobar vessels of the spleen (ULVSs) were exposed by following the space between the two layers of the SRL. b. The terminal branches of the splenic vessels were completely skeletonized by following the intrafascial space.c. Dissection of the adipose tissue around the lymph nodes behind the splenic vessels in front of Gerota's fascia. SRL: Splenorenal ligament; ULVSs ,Upper lobar vessels of spleen; LLVSs,Lower lobar vessels of spleen; SpVs, Splenic vessels; TSV, The terminal branch of splenic vessels
Figure 4.
Intraoperative view after splenic hilar lymphadenectomy.
SPA, splenic artery; SPV, splenic vein.
Table 1.
Comparison of clinicopathological characteristics between the fascia group and the classic group.
Table 2.
Intraoperative and postoperative characteristics.
Table 3.
Lymph node dissection results for the two groups.