Abstract
Objectives. The significance of splenectomy in advanced proximal gastric cancer is examined retrospectively. Methods. From 1994 to 2004, 505 patients with advanced proximal gastric cancer underwent curative total gastrectomy with preserving spleen (T) for 264 patients and total gastrectomy with splenectomy (ST) for 241 patients. Results. Patients who underwent splenectomy showed more advanced lesions. The metastatic rate of lymph node (LN) in the splenic hilus (No. 10) in ST was 18.3%. As for the incidence of surgical complications, there was not statistically difference except for pancreatic fistula. The index of estimated benefit of (No. 10) LN was 4.2, which was similar to that of (No. 9), (No. 11p), (No. 11d), and (No. 16) LNs. 5-year survival rate of (No. 10) positive group was 22.2%. 5-year survival rates of pSE and pN2 in T group were better than that of pSE and pN2 in ST, respectively. The superiority of ST was not confirmed even in Stage II, IIIA, and IIIB. Conclusion. Splenectomy was not effective for patients with (No. 10) metastasis in long-term survival. Spleen-preserving total gastrectomy will be feasible and be enough to accomplish radical surgery for locally advanced proximal gastric cancer.
Highlights
It is well known that lymph node (LN) metastasis is an important factor in the prognosis of gastric cancer, the optical extent of LN dissection remains controversial
Our retrospective study was designed to investigate the significance of splenectomy by evaluating postoperative morbidity, frequency of the each LN metastasis, and long-term surgical outcomes of locally advanced proximal gastric cancer patients who underwent total gastrectomy with R0 resection
In order to accomplish D2 lymphadenectomy, splenectomy had been justified for complete removal of No 10 as extended radical surgery
Summary
It is well known that lymph node (LN) metastasis is an important factor in the prognosis of gastric cancer, the optical extent of LN dissection remains controversial. Previous reports suggested that gastrectomy with splenectomy resulted in better survival than gastrectomy alone in gastric cancer patients [1]. The Japanese retrospective studies revealed that the frequency of LN metastasis to No 10 in proximal gastric cancer was 15–20%, and the 5year survival rate was 20–25% [2, 3]. Total gastrectomy with splenectomy is considered to be a standard procedure for proximal advanced gastric cancer in gastric cancer treatment guidelines [4]. Modified D2 lymphadenectomy avoiding splenectomy is accepted as a standard procedure in the west countries. Our retrospective study was designed to investigate the significance of splenectomy by evaluating postoperative morbidity, frequency of the each LN metastasis, and long-term surgical outcomes of locally advanced proximal gastric cancer patients who underwent total gastrectomy with R0 resection
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
