Impact of Splenectomy in Patients with Gastric Adenocarcinoma of the Cardia

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2007 May 22

PMID 17514409

Citations 25

Authors

Chikara Kunisaki

Hirochika Makino

Hirokazu Suwa

Tsutomu Sato

Takashi Oshima

Yasuhiko Nagano

Syoichi Fujii

Hirotoshi Akiyama

Masato Nomura

Yuichi Otsuka

Hidetaka A Ono

Takashi Kosaka

Ryo Takagawa

Yasushi Ichikawa

Hiroshi Shimada

Affiliations

Soon will be listed here.

Abstract

Previous reports have suggested that splenectomy treatment of gastric carcinoma of the cardia results in poor patient outcome, but the reason for this is unclear. This study aimed to clarify the impact of splenectomy for gastric carcinoma patients. A total of 118 patients with gastric carcinoma of the cardia were enrolled in this study. The characteristics of patients with lymph node metastasis at the splenic hilum were determined, and the effects of lymph node dissection or splenectomy on postoperative morbidity, mortality, and pattern of recurrence were evaluated. Advanced tumors were common in patients with lymph node metastasis at the splenic hilum, Siewert type III, greater curvature sites, larger and deeper tumors, multiple metastatic lymph nodes, and high incidences of para-aortic lymph node metastasis frequently observed. The effectiveness of lymph node dissection of the splenic hilum was low and equal to that of dissection of the para-aortic lymph nodes. Postoperative morbidity, as represented by pancreatic fistula, was high following splenectomy or pancreaticosplenectomy, but patient mortality did not occur. Hematogenous metastasis was common, as well as peritoneal metastasis after curative gastrectomy. Splenectomy should be limited in those patients with gastric cardia tumors invading the spleen or with metastatic bulky lymph nodes extending to the spleen.

Citing Articles

Establishment of a machine learning model for predicting splenic hilar lymph node metastasis.

Ishizu K, Takahashi S, Kouno N, Takasawa K, Takeda K, Matsui K NPJ Digit Med. 2025; 8(1):93.

PMID: 39934302 PMC: 11814149. DOI: 10.1038/s41746-025-01480-x.

Limited Clinical Significance of Splenectomy and Splenic Hilar Lymph Node Dissection for Type 4 Gastric Cancer.

Kunitomo A, Misawa K, Ito Y, Ito S, Higaki E, Natsume S J Gastric Cancer. 2022; 21(4):392-402.

PMID: 35079441 PMC: 8753278. DOI: 10.5230/jgc.2021.21.e37.

Is Splenic Hilar Lymph Node Dissection Without Splenectomy Essential for Proximal Advanced Gastric Cancer?.

Oh Y, Kim D, Eom B, Yoon H, Kim Y, Ryu K Ann Surg Oncol. 2021; 28(13):8952-8961.

PMID: 34275040 DOI: 10.1245/s10434-021-10354-x.

Current status of lymph node dissection in gastric cancer.

Ke B, Liang H Chin J Cancer Res. 2021; 33(2):193-202.

PMID: 34158739 PMC: 8181876. DOI: 10.21147/j.issn.1000-9604.2021.02.07.

Is splenic hilar lymph node dissection necessary for proximal gastric cancer surgery?.

Kinoshita T, Okayama T Ann Gastroenterol Surg. 2021; 5(2):173-182.

PMID: 33860137 PMC: 8034691. DOI: 10.1002/ags3.12413.

References

Bonenkamp J, Hermans J, Sasako M, van de Velde C, Welvaart K, Songun I . Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999; 340(12):908-14. DOI: 10.1056/NEJM199903253401202. View

Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M . Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy--Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004; 22(14):2767-73. DOI: 10.1200/JCO.2004.10.184. View

Otsuji E, Yamaguchi T, Sawai K, Ohara M, Takahashi T . End results of simultaneous splenectomy in patients undergoing total gastrectomy for gastric carcinoma. Surgery. 1996; 120(1):40-4. DOI: 10.1016/s0039-6060(96)80239-x. View

Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V . Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996; 347(9007):995-9. DOI: 10.1016/s0140-6736(96)90144-0. View

Adachi Y, Kamakura T, Mori M, Maehara Y, Sugimachi K . Role of lymph node dissection and splenectomy in node-positive gastric carcinoma. Surgery. 1994; 116(5):837-41. View

Kunisaki C, Shimada H, Ono H, Otsuka Y, Matsuda G, Nomura M . Comparison of results of surgery in the upper third and more distal stomach. J Gastrointest Surg. 2006; 10(5):718-26. DOI: 10.1016/j.gassur.2005.11.002. View

Csendes A, Burdiles P, Rojas J, Braghetto I, Diaz J, Maluenda F . A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma. Surgery. 2002; 131(4):401-7. DOI: 10.1067/msy.2002.121891. View

Weitz J, Jaques D, Brennan M, Karpeh M . Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer. Ann Surg Oncol. 2004; 11(7):682-9. DOI: 10.1245/ASO.2004.03.048. View

Biffi R, Chiappa A, Luca F, Pozzi S, Lo Faso F, Cenciarelli S . Extended lymph node dissection without routine spleno-pancreatectomy for treatment of gastric cancer: low morbidity and mortality rates in a single center series of 250 patients. J Surg Oncol. 2006; 93(5):394-400. DOI: 10.1002/jso.20495. View

10.

Kunisaki C, Shimada H, Takahashi M, Nomura M, Matsuda G, Otsuka Y . Implication of extended lymph node dissection stratified for advanced gastric cancer. Anticancer Res. 2003; 23(5b):4181-6. View

11.

Kitamura K, Nishida S, Ichikawa D, Taniguchi H, Hagiwara A, Yamaguchi T . No survival benefit from combined pancreaticosplenectomy and total gastrectomy for gastric cancer. Br J Surg. 1999; 86(1):119-22. DOI: 10.1046/j.1365-2168.1999.00967.x. View

12.

Wanebo H, Kennedy B, WINCHESTER D, Stewart A, Fremgen A . Role of splenectomy in gastric cancer surgery: adverse effect of elective splenectomy on longterm survival. J Am Coll Surg. 1997; 185(2):177-84. View

13.

Sasako M, McCulloch P, Kinoshita T, Maruyama K . New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg. 1995; 82(3):346-51. DOI: 10.1002/bjs.1800820321. View

14.

Monig S, Collet P, Baldus S, Schmackpfeffer K, Schroder W, Thiele J . Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol. 2001; 76(2):89-92. DOI: 10.1002/1096-9098(200102)76:2<89::aid-jso1016>3.0.co;2-i. View

15.

Japanese Gastric Cancer Association . Japanese Classification of Gastric Carcinoma - 2nd English Edition -. Gastric Cancer. 2002; 1(1):10-24. DOI: 10.1007/s101209800016. View

16.

Roukos D . Current advances and changes in treatment strategy may improve survival and quality of life in patients with potentially curable gastric cancer. Ann Surg Oncol. 1999; 6(1):46-56. DOI: 10.1007/s10434-999-0046-z. View

17.

Maehara Y, Moriguchi S, Yoshida M, Takahashi I, Korenaga D, Sugimachi K . Splenectomy does not correlate with length of survival in patients undergoing curative total gastrectomy for gastric carcinoma. Univariate and multivariate analyses. Cancer. 1991; 67(12):3006-9. DOI: 10.1002/1097-0142(19910615)67:12<3006::aid-cncr2820671213>3.0.co;2-v. View

18.

Brady M, Rogatko A, Dent L, Shiu M . Effect of splenectomy on morbidity and survival following curative gastrectomy for carcinoma. Arch Surg. 1991; 126(3):359-64. DOI: 10.1001/archsurg.1991.01410270105017. View

19.

Lee K, Noh S, Hyung W, Lee J, Lah K, Choi S . Impact of splenectomy for lymph node dissection on long-term surgical outcome in gastric cancer. Ann Surg Oncol. 2001; 8(5):402-6. DOI: 10.1007/s10434-001-0402-0. View

20.

Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono H . Comparison of surgical results of D2 versus D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric carcinoma: a multi-institutional study. Ann Surg Oncol. 2006; 13(5):659-67. DOI: 10.1245/ASO.2006.07.015. View