W Yu1, G S Choi, H Y Chung. 1. Department of Surgery, Kyungpook National University, Taegu 700-721, Korea. wyu@knu.ac.kr
Abstract
BACKGROUND: Preservation or removal of the spleen during total gastrectomy for proximal gastric cancer is a matter of debate. METHODS: A randomized clinical trial included patients with gastric adenocarcinoma who underwent total gastrectomy either with (104 patients) or without (103) splenectomy. Postoperative outcome in the two groups was compared, including morbidity, mortality and survival. RESULTS:Gastrectomy combined with splenectomy tended to be associated with slightly higher morbidity and mortality rates, a slightly greater incidence of lymph node metastasis at the splenic hilum and along the splenic artery, and marginally better survival, but there were no statistically significant differences between the groups. Splenectomy had no impact on survival in patients with metastatic lymph nodes at the hilum of the spleen or in those with metastatic lymph nodes along the splenic artery. CONCLUSION: These results do not support the use of prophylactic splenectomy to remove macroscopically negative lymph nodes near the spleen in patients undergoing total gastrectomy for proximal gastric cancer.
RCT Entities:
BACKGROUND: Preservation or removal of the spleen during total gastrectomy for proximal gastric cancer is a matter of debate. METHODS: A randomized clinical trial included patients with gastric adenocarcinoma who underwent total gastrectomy either with (104 patients) or without (103) splenectomy. Postoperative outcome in the two groups was compared, including morbidity, mortality and survival. RESULTS: Gastrectomy combined with splenectomy tended to be associated with slightly higher morbidity and mortality rates, a slightly greater incidence of lymph node metastasis at the splenic hilum and along the splenic artery, and marginally better survival, but there were no statistically significant differences between the groups. Splenectomy had no impact on survival in patients with metastatic lymph nodes at the hilum of the spleen or in those with metastatic lymph nodes along the splenic artery. CONCLUSION: These results do not support the use of prophylactic splenectomy to remove macroscopically negative lymph nodes near the spleen in patients undergoing total gastrectomy for proximal gastric cancer.
Authors: Bang Wool Eom; Young-Woo Kim; Sang Eok Lee; Keun Won Ryu; Jun Ho Lee; Hong Man Yoon; Soo-Jeong Cho; Myeong-Cherl Kook; Soo Jin Kim Journal: Surg Endosc Date: 2012-05-31 Impact factor: 4.584
Authors: David J Worhunsky; Yulia Zak; Monica M Dua; George A Poultsides; Jeffrey A Norton; Brendan C Visser Journal: J Gastrointest Surg Date: 2014-06-18 Impact factor: 3.452