Lymph node metastasis at the splenic hilum in proximal gastric cancer.

We performed splenectomy on patients with macroscopic advanced gastric cancer located at the proximal part of the stomach to achieve complete D2 lymphadenectomy. The aim of this study was to clarify the survival benefit of splenectomy in the treatment of gastric cancer. The clinical records of 225 patients who underwent total gastrectomy with splenectomy for gastric cancers involving the proximal part of the stomach were analyzed retrospectively. Nodal involvement at the splenic hilum (no. 10) was detected in 47 cases (20.9%). All of these cases were macroscopically diagnosed as positive for serosal invasion or regional lymph node metastasis at the time of surgery. In considering the lymphatic pathway from the primary tumor to no. 10 lymph nodes, metastasis at lymph nodes along the lesser curvature (no. 3), the short gastric vessels, or the gastroepiploic vessels (no. 4) may be good indicators of no. 10 lymph node metastasis. The overall survival of 47 patients with positive no. 10 lymph nodes was extremely poor. However, when curative surgery was performed, the survival of no. 10 positive patients was not different from that of no. 10 negative patients. Thus, for patients with advanced gastric cancer located in the proximal part of the stomach, D2 lymphadenectomy with splenectomy is recommended when patients show macroscopic evidence of serosal invaded tumor with regional lymph node metastasis.