Splenectomy in Patients with Proximal Gastric Cancer: Early RESULTS of a Prospective Randomized Trial

Yu, Wansik; Choi, Gyu Seog; Chung, Ho Young

Abstract

PURPOSE: The preservation or removal of the spleen during a total gastrectomy has been greatly debated. We analyzed early results of a prospective randomized trial of 146 patients with gastric cancer who underwent a total gastrectomy to evaluate the impact of a combined splenectomy on the postoperative course.
METHODS
Patients were randomized intraoperatively using a computer-generated random number table to remove the spleen versus preservation of the spleen.
RESULTS
There were 73 patients in the preservation group and 73 in the splenectomy group. There was one patient in the preservation group who died of postoperative complication. There were two deaths in the splenectomy group. After a splenectomy 27% of the patients experienced postoperative complications versus 25% in the preservation group. Preservation of the spleen showed improved overall survival as compared to a splenectomy, but this difference was not statistically significant. For patients with curative resections, the 3-year survival tended to be higher after preservation of the spleen (0.7146 versus 0.5203; p=0.1038). Improvement in survival was not statistically significant for subgroups of patients with metastatic lymph nodes at the hilum of the spleen (p=0.9303), and in subgroups of patients with metastatic lymph nodes along the splenic artery (p= 0.8681).
CONCLUSION
Survival benefit with or without preservation ofthe spleen during total gastrectomy in patients with gastric cancer will be clarified on continued follow-up.