Comparison of Early Postoperative Outcomes after Total Gastrectomy and D2 Lymph Node Dissection with and without Splenectomy

Abstract

INTRODUCTION A famous prognostic ingredient for gastric cancer is the lymph node metastasis. In the gastric cancer treatment, splenectomy was considered as a part of lymphadenec-tomy, and previous reports revealed better results for survival in patients with splenectomy. . 1 Especially for tumors situated in the proximal stomach, total gas-trectomy (TG) and splenectomy was considered to be a standard procedure because of the high frequency of Lymph Nodes (LN) metastasis to hilar nodes for proximal gastric tumors. 2 On the contrary, some researchers suggested that splenectomy could be a cause of additional morbidity and mortality 3,4 and also recent reports showed that splenectomy had no effect on survival for proximal gastric tumors. 5,6 Currently, preservation of the spleen is the accepted approach during total gastrectomy, and routine splenectomy is not recommended. The aim of this study was to estimate the impression of splenectomy for D2 lymph node dissection with total gastrectomy. METHODOLOGY Between February 1998 and January 2012, 1531 patients treated for gastric cancer. Two hundred and ninety-six of them underwent TG with D2 lymphadenectomy. Because of the tumor invasion to the adjacent organs; distal pancreatectomy and splenectomy was performed in 39 patients, which were excluded from this study. Left behind 257 patients, total gastrectomy with simultaneous splenectomy was performed in 205 patients and the remaining 52 underwent a spleen-preserving total gas-trectomy. The clinical features, mortality and morbidity rates of the groups were compared. The clinical specifications which could potentially affect early postoperative results included age (<70 vs. ≥ SUMMARY Background: A famous prognostic ingredient for gastric cancer is the lymph node metastasis. Previously in the therapy of gastric cancer, splenectomy was considered as a definitive part of lymph node dissec-tion. Currently, preservation of the spleen is the accepted approach during total gastrectomy and routine splenectomy is abandoned. The aim of this study was to estimate the impression of splenectomy for D2 lymph node dissection with total gastrectomy.