Abstract
BackgroundFor proximal gastric cancer invading the greater curvature, concomitant splenectomy is frequently performed to secure the clearance of lymph node metastases. However, prognostic impact of prophylactic splenectomy remains unclear. The aim of this study was to clarify the oncological significance of prophylactic splenectomy for advanced proximal gastric cancer invading the greater curvature.MethodsRetrospective review of 108 patients who underwent total or subtotal gastrectomy for advanced proximal gastric cancer involving the greater curvature was performed. Short-term and long-term outcomes were compared between the patients who underwent splenectomy (n = 63) and those who did not (n = 45).ResultsPatients who underwent splenectomy showed higher amount of blood loss (538 vs. 450 mL, p = 0.016) and morbidity rate (30.2 vs. 13.3, p = 0.041) compared with those who did not undergo splenectomy. In particular, pancreas-related complications were frequently observed among patients who received splenectomy (17.4 vs. 0%, p = 0.003). However, no significant improvement of long-term outcomes were confirmed in the cases with splenectomy (5-year recurrence-free rate, 60.2 vs. 67.3%; p = 0.609 and 5-year overall survival rates, 63.7 vs. 73.6%; p = 0.769). On the other hand, splenectomy was correlated with marginally better survival in patients with Borrmann type 1 or 2 gastric cancer (p = 0.072).ConclusionsFor advanced proximal gastric cancer involving the greater curvature, prophylactic splenectomy may have no significant prognostic impact despite the increased morbidity rate after surgery. Such surgical procedure should be avoided as long as lymph node involvement is not evident.
Highlights
For proximal gastric cancer invading the greater curvature, concomitant splenectomy is frequently performed to secure the clearance of lymph node metastases
For patients with advanced gastric cancer not involving the greater curvature of the stomach, a prospective study conducted by the Japan Clinical Oncology Group (JCOG0110) has confirmed that concurrent splenectomy has no oncological advantage despite the increased morbidity [5], and prophylactic splenectomy is currently not recommended for such cases in the Japanese Gastric Cancer Treatment Guidelines [6]
Operative duration and curability of surgery did not differ between the groups, whereas the amount of blood loss was significantly higher in the splenectomy group
Summary
For proximal gastric cancer invading the greater curvature, concomitant splenectomy is frequently performed to secure the clearance of lymph node metastases. The aim of this study was to clarify the oncological significance of prophylactic splenectomy for advanced proximal gastric cancer invading the greater curvature. Concurrent splenectomy or distal pancreatectomy has been performed in selected cases with advanced gastric cancer to secure the clearance of potential nodal involvement at the splenic hilum or along the splenic artery. For advanced gastric cancer involving the greater curvature, concurrent splenectomy remains a standard procedure despite that no solid evidence has been available. This study sought to clarify the prognostic impact of splenectomy for patients with proximal advanced gastric cancer involving the greater curvature of the stomach.
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