A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

Abstract

Background The overall prognosis and survival of patients with advanced gastric cancer are generally poor. Extended lymphadenectomy is recommended for patients with advanced gastric cancer; however, splenectomy and distal pancreatectomy performed with an extended lymph node dissection may be associated with increased morbidity and mortality. Method Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 31 December 2009. Studies on gastric carcinoma investigating extended lymphadenectomy with splenectomy and/or pancreaticosplenectomy that reported data on surgical outcomes or survival were selected. Results Forty studies were included in this review. Decreased complication rates were demonstrated with spleen preservation in two prospective studies and three retrospective studies, and with pancreas preservation in five retrospective studies. No randomized controlled trial showed survival benefit or detriment for preservation of spleen or pancreas in extended lymphadenectomy. Improved survival was demonstrated with spleen preservation in two prospective and eight retrospective studies, and with pancreas preservation in one prospective and four retrospective studies. Conclusions Preservation of the spleen and pancreas during extended lymphadenectomy for gastric cancer decreases complications with no clear evidence of improvement or detriment to overall survival.

Therapeutic role of systematic lymphadenectomy in early-stage endometrial cancer: A systematic review

“…A similar story emerges from systematic reviews of lymphadenectomy to treat for other malignancies, including prostatic cancer (37) and gastric cancer (38,39). These reviews come to divergent conclusions, and the overall evidence of clinical benefit is weak.…”

Lymph Node Dissection in Resectable Advanced Gastric Cancer

“…A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer was recently presented by Brar et al [35]. Besides the randomized trials, 37 articles with 6,354 patients were included in this review.…”

“…A meta-analysis on perioperative survival with the data from these randomized trials showed no statistically significant difference (OR: 1.59, 95% CI: 0.44-5.79) [35]. A large randomized trial to evaluate the use of splenectomy in gastric cancer is currently underway in Japan [36].…”

Should we remove splenic hilus lymph nodes for esophagogastric junction adenocarcinoma?

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“…A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer was recently presented in Gastric Cancer by Brar et al [11]. From this analysis it is concluded that ''despite the concern about the increased morbidity and mortality of splenectomy and distal pancreatectomy during extended lymphadenectomy for gastric cancer as demonstrated in some studies, more contemporary studies demonstrate that this procedure can still be done safely with low short-term morbidity and mortality for patients undergoing curative surgery for gastric cancer.''…”