Suppression of T-cell function in gastric cancer patients after total gastrectomy with splenectomy: implications of splenic autotransplantation

Abstract

Abstract:Background. In Japan since the 1960s, patients with gastric cancer have routinely had splenectomy combined with gastrectomy to ensure that lymph node dissection is complete. However, the influence of splenectomy on long-term immunity is unclear. Methods. Forty-nine gastric cancer patients who underwent total gastrectomy for cure with (n ‫؍‬ 25) and without (n ‫؍‬ 24) splenectomy were assessed for immunologic function, including the proportion of lymphocyte subsets, purified protein derivative from tuberculin (PPD) response, natural killer (NK) activity, and phytohemagglutinin (PHA) response. Results. Peripheral T-cell mediated functions, e.g., PPD and PHA response, were significantly suppressed in patients who underwent gastrectomy with splenectomy compared with those who had gastrectomy alone. Decreased T-cell subsets (CD 3؉, 4؉, 8؉) and increased NK cell subsets (CD 16؉, 57؉) were observed in patients who underwent splenectomy. Patients who did not undergo splenectomy had immunologic responses within the normal range. Conclusions. Splenectomy decreased T-cell mediated responses over the long term. As a potential means to correct this T-cell dysfunction in patients with splenectomy, splenic autotransplantation should be considered in future research.

Impact of splenectomy on circulating T‐lymphocyte subsets in stage III gastric cancer

“…Okuno et al . reported that CD3, CD4 and CD8 decreased and CD16 increased in gastric cancer patients with splenectomy more than 2 years following curative total gastrectomy 2 . In our study, the proportion of lymphocytes, and the numbers of CD3, CD8, CD16 and CD25 were higher in the splenectomy group at postoperative month 3, the mid‐point of postoperative chemotherapy.…”

Influence of splenectomy in patients with liver cirrhosis and hypersplenism

“…SPLENECTOMY IS A common treatment used to improve hypersplenic thrombocytopenia in cirrhotic patients with splenomegaly in Japan . Splenectomy has recently been applied as another option to cure hepatocellular carcinoma (HCC) and for cirrhotic patients with no potential donor for liver transplantation.…”

“…S PLENECTOMY IS A common treatment used to improve hypersplenic thrombocytopenia in cirrhotic patients with splenomegaly in Japan. [1][2][3][4][5][6][7] Splenectomy has recently been applied as another option to cure hepatocellular carcinoma (HCC) and for cirrhotic patients with no potential donor for liver transplantation. Thus, the clinical application of splenectomy has been expanded; however, the immunophysiology of the spleen in cirrhotic patients and the long-term outcome after splenectomy have not been clarified.…”

Resektionsausmaß in der Chirurgie des Magenkarzinoms

“…Das Argument für die Splenektomie ist die Inzidenz von Lymphknotenmetastasen entlang der peripheren A. lienalis und im Milzhilus. So ist die T-Zell-Funktion nach Splenektomie signifikant vermindert [44]. In einer britischen und einer amerikanischen Analyse fand sich wie im MRC-Trial ein negativer Einfluss der Splenektomie auf das Überleben [21,55].…”