Value of splenectomy in patients with Siewert type II adenocarcinoma of the esophagogastric junction

Goto, Hironobu; Tokunaga, Masanori; Sugisawa, Norihiko; Tanizawa, Yutaka; Bando, Etsuro; Kawamura, Taiichi; Niihara, Masahiro; Tsubosa, Yasuhiro; Terashima, Masanori

doi:10.1007/s10120-012-0214-x

Cited by 30 publications

(25 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10 lymph node dissection in patients with advanced proximal gastric cancer and is associated with better survival outcomes. However, many negative studies on the performance of splenectomy have been published because of the high morbidity rate and low survival benefit [28,29] . In addition, a randomized controlled trial (JCOG0110) more recently revealed that spleen preservation was non-inferior to splenectomy in overall survival for patients with gastric cancer that does not invade the greater curvature [30] .…”

Section: Discussionmentioning

confidence: 99%

A Risk Model for Surgical Site Infection in the Gastric Cancer Surgery Using Data of 790 Patients

Ushiku¹,

Hosoda²,

Yamashita³

et al. 2015

Dig Surg

View full text Add to dashboard Cite

Background: Understanding risk factors of surgical site infections (SSIs) in gastrectomy is important to provide the best treatment for the patients with gastric cancer. Methods: This is a retrospective observational study using the medical records of 790 patients with gastrectomy from 2005 through 2009. SSIs were classified into incisional SSIs (iSSIs) and organ/space SSIs (o/sSSIs). Results: iSSIs and o/sSSIs were detected in 41 (5.2%) patients and 68 (8.6%) patients, respectively. Open surgery was the only independent risk factor (p = 0.028) for iSSIs, while open surgery (p = 0.004), concurrent splenectomy (p < 0.001), operative time ≥220 min (p = 0.009), preoperative body mass index ≥20.8 kg/m² (p = 0.004) and male gender (p = 0.028) were the independent risk factors for o/sSSIs. We created a risk model for o/sSSIs using these independent risk factors. The C-index model discrimination was 0.84 (p < 0.001), and the calibration of the models demonstrated a linear correlation between the predicted and observed probability. Conclusion: We reported the risk factors of SSIs for gastrectomy. The risk model developed in this study for o/sSSIs pertaining to gastric cancer surgery would contribute to provide guidance for the development of best practices.

show abstract

Section: Discussionmentioning

confidence: 99%

A Risk Model for Surgical Site Infection in the Gastric Cancer Surgery Using Data of 790 Patients

Ushiku¹,

Hosoda²,

Yamashita³

et al. 2015

Dig Surg

View full text Add to dashboard Cite

show abstract

“…In terms of the impact of splenectomy on surgical outcome, a recent randomised trial reported that it failed to improve survival in patients with proximal gastric cancer not invading the greater curvature (7). Moreover, another study reported that splenectomy with splenic hilar lymph node dissection had no survival benefit in patients with EGJ carcinoma (8). In the current study, patients treated with spleen preservation had a significantly longer OS than those treated with splenectomy.…”

Section: Discussionmentioning

confidence: 43%

“…A recent randomised trial reported that splenectomy should be avoided because it increased operative morbidity without improving survival in patients undergoing total gastrectomy for proximal gastric cancer not invading the greater curvature (7). Moreover, a previous study reported that splenic hilar lymph node dissection could be omitted from EGJ carcinoma surgery without decreasing curability, based on the index of estimated benefit from lymph node dissection (8). However, this study did not establish the value of splenectomy or not in patients with EGJ carcinoma.…”

mentioning

confidence: 83%

Prognostic Impact of Splenectomy in Patients with Esophagogastric Junction Carcinoma

Fukuchi

Mochiki

Ishiguro

et al. 2018

View full text Add to dashboard Cite

Abstract. Background p=0.04) and venous invasion (OR=3.03; p=0.02) The incidence of adenocarcinoma of the oesophagogastric junction (EGJ) is increasing in both Western and Eastern countries (1). The Siewert classification of EGJ adenocarcinomas has been widely accepted (2), while the current classification system in Japan designates a tumor as an EGJ carcinoma, regardless of its histological type, when its epicentre is located within 2 cm proximal or distal to the EGJ (3). Moreover, though in these EGJ carcinomas are less than 4 cm in diameter, the algorithm was established to provide a tentative standard for lymphadenectomy based on the results of a retrospective multi-institutional study in Japanese guidelines (4). However, the final results of this study did not alter the recommendations, and the optimal surgical procedures for EGJ carcinoma, including the surgical approach (transthoracic or transhiatal), range of lymphadenopathy and type of gastrectomy remain controversial.The European Society for Medical Oncology clinical practice guidelines recommend D2 gastrectomy for curable gastric cancer. However, splenectomy is not recommended unless the tumor is directly infiltrating the spleen (5, 6). In contrast, Japanese guidelines include splenectomy in D2 total gastrectomy (3). A recent randomised trial reported that splenectomy should be avoided because it increased operative morbidity without improving survival in patients undergoing total gastrectomy for proximal gastric cancer not invading the greater curvature (7). Moreover, a previous study reported that splenic hilar lymph node dissection could be omitted from EGJ carcinoma surgery without decreasing curability, based on the index of estimated benefit from lymph node dissection (8). However, this study did not establish the value of splenectomy or not in patients with EGJ carcinoma.Further information regarding the survival benefits of splenectomy will help determine the optimal surgical procedure in patients with ECJ carcinoma. We retrospectively examined clinicopathological and survival data for surgically treated patients with ECJ carcinoma, to determine the benefits of splenectomy. Patients and MethodsPatients. We retrospectively reviewed a database of 60 patients with EGJ carcinoma who had undergone macroscopically complete resection (R0 or R1) at

show abstract

“…However, the treatment of gastric cancer or EGJ cancer with splenectomy is controversial. Numerous studies on treatment of cancer with splenectomy have been published describing the high morbidity rates and low survival rate benefits of such treatment (25). However, Huang et al (26) reported that splenectomy is beneficial for splenic hilar lymph node dissections in patients with advanced proximal gastric cancer and is associated with improved survival rates.…”

Section: Rta (N=30) -------------------------------------------------mentioning

confidence: 99%

Prognoses of advanced esophago‑gastric junction cancer may be modified by thoracotomy and splenectomy

et al. 2017

View full text Add to dashboard Cite

Abstract. Globally, the incidence of esophago-gastric junction (EGJ) cancer is rapidly increasing. However, the proposed strategies for the treatment of these types of cancer are so diverse that there is no established consensus on the optimal treatment. The aim of the present study was to identify independent prognostic factors to delineate the optimal strategies for the treatment of EGJ cancer. The medical records of 150 patients with EGJ cancer who underwent curative surgery at the Kitasato University were retrospectively reviewed. The median follow-up period was 48 months. The patients with tumors that were classified as post-treatment primary tumor stage 3 [(y)pT3] or higher had a 5-year disease-specific survival (DSS) rate of 53%, whereas those with tumors that were classified as (y)pT0-2 had a 5-year DSS rate of 90%. Therefore, prognostic analysis was restricted to those tumors that were designated (y)pT3 or higher. A multivariate Cox's proportional hazards model identified the following independent prognostic factors that negatively influenced the DSS: i) Presence of tumors classified as post-treatment regional lymph node stage 1-3 [(y)pN1-3] [hazard ratio (HR), 3.62; 95% confidence interval (CI), 1.39-12.36]; ii) not undergoing treatment with splenectomy (HR, 2.40; 95% CI, 1.15-5.15); and iii) undergoing treatment with thoracotomy (HR, 2.07; 95% CI, 1.02-4.23). In patients with (y)pN0 tumors, the DSS rate was significantly improved for those who underwent splenectomy than for those who did not (P=0.024). In patients with (y)pN1-3 tumors, the DSS rate was significantly worse for those who underwent thoracotomy compared with those who did not (P=0.004). Splenectomy and thoracotomy may critically affect prognosis in locally advanced EGJ cancer that are classified as (y)pN0 and (y)pN1-3, respectively. Surgical treatments require optimization in order to improve prognoses in advanced EGJ cancer.

show abstract

Value of splenectomy in patients with Siewert type II adenocarcinoma of the esophagogastric junction

Abstract: Splenic hilar lymph node dissection may be omitted without decreasing curability in patients with Siewert type II AEG, although a prospective study is necessary for more conclusive results.

Cited by 30 publications

References 29 publications

A Risk Model for Surgical Site Infection in the Gastric Cancer Surgery Using Data of 790 Patients

A Risk Model for Surgical Site Infection in the Gastric Cancer Surgery Using Data of 790 Patients

Prognostic Impact of Splenectomy in Patients with Esophagogastric Junction Carcinoma

Prognoses of advanced esophago‑gastric junction cancer may be modified by thoracotomy and splenectomy

Contact Info

Product

Resources

About