Chikara Kunisaki1, Sho Sato2, Nobuhiro Tsuchiya2, Jun Watanabe2, Tsutomu Sato2, Kazuhisa Takeda2, Kohei Kasahara3, Takashi Kosaka3, Hirotoshi Akiyama3, Itaru Endo3, Toshihiro Misumi4. 1. Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan s0714@med.yokohama-cu.ac.jp. 2. Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan. 3. Department of Gastroenterological Surgery, School of Medicine, Yokohama City University, Yokohama, Japan. 4. Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama, Japan.
Abstract
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 meta-analysis 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 spleen-preserving 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. Copyright
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 meta-analysis 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 spleen-preserving 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. Copyright
Authors: Beverley J Shea; Barnaby C Reeves; George Wells; Micere Thuku; Candyce Hamel; Julian Moran; David Moher; Peter Tugwell; Vivian Welch; Elizabeth Kristjansson; David A Henry Journal: BMJ Date: 2017-09-21