Abstract
BackgroundsPatients with proximal gastric carcinoma undergo total gastrectomy with concomitant splenectomy to ensure the complete removal of splenic hilar lymph nodes. However, the impact of splenectomy on survival remains uncertain. This study aimed to investigate the impact of splenectomy on survival among patients with gastric carcinoma.MethodsOf 1074 patients who underwent total gastrectomy for proximal gastric carcinoma between 2006 and 2014, 229 patients underwent concomitant splenectomy or pancreaticosplenectomy during surgery. We investigated the prognostic impact of splenectomy using a regression and propensity score matched model.ResultsThe splenectomy and non-splenectomy groups differed in many baseline characteristics, including tumor stage, and had respective crude 5-year survival rates of 55% and 81% (p <0.001). In a multivariate analysis adjusted for TNM stage and other prognostic factors, splenectomy was an independent poor prognostic factor for overall survival (hazard ratio [HR] = 1.67, 95% confidence interval [CI] = 1.11–2.51) and disease-free survival (HR = 1.61, 95% CI = 1.24–2.10). A survival evaluation stratified by TNM stage showed that splenectomy adversely affected survival among patients with stage III, but not stage I, II, and IV disease. In the propensity score-matched sample, splenectomy group also showed significantly worse overall survival (5-year, 65% vs. 79%, p = 0.010) and disease-free survival (5-year, 55% vs. 72%, p = 0.025) and was an independent poor prognostic factor in a multivariate analysis adjusting TNM stage and other prognostic factors.ConclusionsSplenectomy adversely affects survival, particularly among patients with stage III gastric carcinoma, and should be avoided unless there is direct invasion to the splenic hilum.
Highlights
The global incidence of gastric carcinoma is generally decreasing, the incidence of proximal gastric carcinoma, including cancer of the gastric cardia, has remained stable or increased, at least in Western countries [1]
We investigated the prognostic impact of splenectomy using a regression and propensity score matched model
In a multivariate analysis adjusted for tumor node metastasis (TNM) stage and other prognostic factors, splenectomy was an independent poor prognostic factor for overall survival and disease-free survival (HR = 1.61, 95% CI = 1.24–2.10)
Summary
The global incidence of gastric carcinoma is generally decreasing, the incidence of proximal gastric carcinoma, including cancer of the gastric cardia, has remained stable or increased, at least in Western countries [1]. Total gastrectomy combined with adequate lymph node (LN) dissection is currently the treatment procedure of choice for proximal gastric carcinoma, and splenectomy or pancreaticosplenectomy is performed intraoperatively when a tumor has directly invaded the spleen or pancreas. Even without such direct invasion, splenectomy is performed to completely remove LNs at the splenic hilum as part of D2 lymphadenectomy. Some previous studies have shown that patients with metastasis to the splenic hilar LNs have a very poor prognosis even after curative surgery [2,3,4], and splenectomy only increases the morbidity and mortality associated with proximal gastric carcinoma without providing survival benefits [6, 7]. In this study we investigated the impact of splenectomy on survival among 1074 patients who underwent total gastrectomy for proximal gastric carcinoma, using a regression and propensity score-matched analysis
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