The negative effect of splenectomy on the prognosis of gastric cancer.

During the 11 year period from 1970 through 1980, 103 patients underwent total gastrectomy for gastric cancer. Splenectomy was performed in 53 of the patients because of perioperative accidental injury or an operative finding of tumor metastasis to the lymph nodes or direct invasion to the splenic hilus. Retrospective comparisons were carried out among the 53 splenectomized and 50 nonsplenectomized patients in terms of the long-term survival rate and early and late complications. The two groups of patients were quite similar with regard to rates of curative resection and stages of disease. The 5 year cumulative survival rates overall and in the splenectomized and nonsplenectomized groups were 23.1, 21.8 and 23.8 percent, respectively. Splenectomy did not affect the prognosis of gastric cancer. In addition, there were no differences between the two groups in the incidences of early surgical complications and infectious disease of late onset. Our results suggest that, in the treatment of gastric cancer, splenectomy may not be avoided, either when the spleen is injured perioperatively or when cancer involvement is suspected in the splenic hilus.