Is concomitant splenectomy beneficial for the long-term survival of patients with gastric cancer undergoing curative gastrectomy? A single-institution study

Zhang, Hao; Pang, Deyan; Xu, Huanming; Ren, Yuan; Liu, Caigang

doi:10.1186/1477-7819-12-193

Cited by 9 publications

(8 citation statements)

References 17 publications

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“…There was no significant difference in mortality in four studies (20,22,23,26); however, one study showed barely significant difference in mortality between gastrectomy with and without splenectomy (2.7% vs. 0.4%, respectively, p=0.048) (19). The remaining three studies did not report the outcomes of mortality (22,24,25). All studies showed the superiority of spleen preservation for OS by univariate analysis; however, three studies showed no significant between-group difference in OS on sub-group analysis disaggregated by disease stage (19)(20)(21).…”

Section: Resultsmentioning

confidence: 96%

“…A total of eight retrospective studies (combined n=3,676) showed the beneficial effect of spleen-preserving gastrectomy. Of these, four articles were published from Korea (19)(20)(21)(22), three were from China (23)(24)(25) and one was from Germany (26). In four studies, the incidence of postoperative morbidity was significantly higher in the splenectomy compared to the non-splenectomy groups (19,21,22,25).…”

Section: Resultsmentioning

confidence: 99%

“…Of these, four articles were published from Korea (19)(20)(21)(22), three were from China (23)(24)(25) and one was from Germany (26). In four studies, the incidence of postoperative morbidity was significantly higher in the splenectomy compared to the non-splenectomy groups (19,21,22,25). Two studies showed no significant betweengroup difference in the incidence of postoperative morbidity (23,26), while two studies did not report on this topic (20,24).…”

Section: Resultsmentioning

confidence: 99%

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Systemic Review and Meta-analysis of Impact of Splenectomy for Advanced Gastric Cancer

Kunisaki

Sato

Tsuchiya

et al. 2020

In Vivo

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Background/Aim: Prophylactic splenectomy has shown no inferiority for tumors not invading the greater curvature side. Despite this, the clinical impact of prophylactic splenectomy for proximal advanced gastric cancer is not clear. This review aimed to clarify the impact of splenectomy for advanced gastric cancer in the upper third of the stomach. Materials and Methods: A systematic review and metaanalysis were conducted based on PubMed and EMBASE databases. The following search terms were used: "gastric cancer" OR "splenectomy" OR upper third of the stomach" OR preservation of the spleen. Results: Out of 765 articles, 18 studies (combined n=6,341) were included in the analysis. Four randomized controlled trials (RCT) and eight retrospective studies suggested the benefits of spleenpreserving gastrectomy. Six retrospective studies showed no significant benefit of spleen-preserving gastrectomy. Prophylactic splenectomy showed a close association with a higher incidence of postoperative morbidity (pancreatic fistula and anastomotic leakage) with no concomitant improvement in overall survival. Prophylactic splenectomy should not be routinely performed and RCTs are necessary to confirm the impact of splenectomy for cN(+) at the splenic hilum tumors and tumors invading the greater curvature.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Systemic Review and Meta-analysis of Impact of Splenectomy for Advanced Gastric Cancer

Kunisaki

Sato

Tsuchiya

et al. 2020

In Vivo

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“…At the randomized controlled trial of Toge et al (1985) splenectomy had positive effect on overall survival compared to the non-splenectomy group (71.7% vs 56%). However, at some retrospective studies, splenectomy had a negative effect on overall survival (Ito et al, 2013;Nashimoto et al, 2012;Zhang et al, 2014). Another important issue is station 10 lymph node dissection.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Morbidity and Mortality in Gastrectomy Cases with Splenectomy

Kalaycı

İliklerden

Kotan

2022

Black Sea Journal of Health Science

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Gastric cancer is a worldwide health problem. The addition of splenectomy to gastrectomy is a controversial issue, especially in cases located on the greater curvature. In this study, it is aimed to find the factors affecting morbidity and mortality in gastrectomy cases with splenectomy. Patients who underwent surgery for gastric cancer in Van Yuzuncu Yil University, Department of General Surgery between January 2010 and January 2018 were retrospectively selected. Splenectomy cases were filtered out in all gastrectomy patients. Preoperative, intraoperative and postoperative data of the patients were collected. The effects of the collected parameters on morbidity and mortality were evaluated. A p value of less than 0.05 was considered statistically significant. 45 patients were included in the study. The mean age of all patients was 64.2 years (32-85) and the male to female ratio was 27/18. Thirty seven cases (82.2%) were operated under elective conditions. The most common tumor location was cardia (n=24, 53.3%) and the most common surgical method (n=39) was total gastrectomy (86.7%). Morbidity and mortality rate of the study were 46.6% (n=21) and 17.8% (n=8), respectively. Mortality increased in patients who were operated in emergency conditions and received neoadjuvant therapy, p=0.002 and P=0.044, respectively. While surgery under emergency conditions increased mortality, preoperative neoadjuvant treatment decreased mortality. However, there was no factor affecting morbidity. Splenectomy in gastric cancer surgery, if possible, should be performed under elective conditions and after neoadjuvant therapy to reduce mortality.

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“…The immune function of the spleen against cancer is unclear. A large‐scale cohort study (mostly involving patients undergoing splenectomy for treatment of trauma) 23 demonstrated a high risk of cancer development in the long‐term follow up. However, the relationship of splenectomy with cancer recurrence has not been clearly shown.…”

Section: Previous Reports On Presence or Absence Of Splenectomy And Dmentioning

confidence: 99%

Is splenic hilar lymph node dissection necessary for proximal gastric cancer surgery?

Kinoshita

Okayama

2020

Annals of Gastroent Surgery

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Advanced proximal gastric cancer sometimes metastasizes to the splenic hilar lymph nodes (No. 10 LN). Total gastrectomy combined with splenectomy is performed for complete removal of the No. 10 LN and was historically a standard procedure in Japan. However, splenectomy is associated with several disadvantages for patients, such as increased postoperative morbidity, risk of thrombogenic disease, fatal infection from encapsulated bacteria, and the development of other types of cancer in the long term because of loss of immune function. Therefore, splenectomy should only be performed when its estimated oncological effect exceeds such disadvantages. A Japanese randomized controlled trial (JCOG0110) clearly demonstrated that prophylactic splenectomy is not necessary unless the tumor has invaded the greater curvature; thus, splenectomy is no longer routinely performed in Japan. However, several retrospective studies have shown a comparatively high incidence of No. 10 LN metastasis and therapeutic value from LN dissection at that station in the tumors invading the greater curvature. Similar tendencies have also been reported in type 4 or remnant gastric cancer involving the greater curvature. In view of these facts, No. 10 LN dissection is presently recommended for such patients; however, robust evidence is lacking. In recent years, laparoscopic/robotic spleen‐preserving splenic hilar dissection utilizing augmented visualization without pancreatic mobilization has been developed. This procedure is expected to replace prophylactic splenectomy and provide an equal oncological effect with lower morbidity. In Japan, a prospective phase‐II study (JCOG1809) is currently ongoing to investigate the safety and feasibility of this procedure.

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Is concomitant splenectomy beneficial for the long-term survival of patients with gastric cancer undergoing curative gastrectomy? A single-institution study

Cited by 9 publications

References 17 publications

Systemic Review and Meta-analysis of Impact of Splenectomy for Advanced Gastric Cancer

Systemic Review and Meta-analysis of Impact of Splenectomy for Advanced Gastric Cancer

Factors Affecting Morbidity and Mortality in Gastrectomy Cases with Splenectomy

Is splenic hilar lymph node dissection necessary for proximal gastric cancer surgery?

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