Significance of a Splenectomy with a Curative Total Gastrectomy for Gastric Cancer A trospective analysis of 237 cases

Lee, Jae Bok; Mok, Young Jae

Abstract

BACKGROUNDS: A splenectomy is often performed simultaneously with a total gastrectomy for lymph node dissection in gastric cancer. The therapeutic value of a splenectomy in a curative total gastrectomy is controversial. The purpose of this retrospective study is to evaluate the impact of a splenectomy combined with a total gastrectomy on the survival and the postoperative morbidity in gastric cancer.
METHODS
From among 343 patients with total gastrectomy for gastric cancer between September 1983 and December 1996, we analyzed 237 patients who underwent a curative resection : 107 patients with a splenectomy and 130 patients without a splenectomy.
RESULTS
There were significant differences between the patients with and without a splenectomy with regard to type of cancer, tumor size, and depth of invasion. In those who underwent a splenectomy, the tumor was larger, Borrman type III lesions were more frequent, the depth of invasion was greater, and an advanced stage was more frequent. The 5-year survival rate of the patients with a splenectomy was insignificantly less than that of those without splenectomy (50.6% vs. 57.7%, P> 0.05). There was no significant difference in the survival time according to the stage. Postoperative complications occurred more commonly in the patients of a splenectomy than those without a splenectomy (22.4% vs. 14.6%).
CONCLUSIONS
We conclude that a splenectomy did not affect the prognosis for patients with gastric cancer and that efforts should be made to preserve the spleen during a gastrectomy. A prospective study should be done to better define the relationship between a splenectomy and the survival time of patients with gastric cancer.