Adverse prognostic impact of splenectomy on survival in gastric carcinoma patients: Regression and propensity score matching analysis of 1074 patients

Abstract

BackgroundsPatients with proximal gastric carcinoma undergo total gastrectomy with concomitant splenectomy to ensure the complete removal of splenic hilar lymph nodes. However, the impact of splenectomy on survival remains uncertain. This study aimed to investigate the impact of splenectomy on survival among patients with gastric carcinoma.MethodsOf 1074 patients who underwent total gastrectomy for proximal gastric carcinoma between 2006 and 2014, 229 patients underwent concomitant splenectomy or pancreaticosplenectomy during surgery. We investigated the prognostic impact of splenectomy using a regression and propensity score matched model.ResultsThe splenectomy and non-splenectomy groups differed in many baseline characteristics, including tumor stage, and had respective crude 5-year survival rates of 55% and 81% (p <0.001). In a multivariate analysis adjusted for TNM stage and other prognostic factors, splenectomy was an independent poor prognostic factor for overall survival (hazard ratio [HR] = 1.67, 95% confidence interval [CI] = 1.11–2.51) and disease-free survival (HR = 1.61, 95% CI = 1.24–2.10). A survival evaluation stratified by TNM stage showed that splenectomy adversely affected survival among patients with stage III, but not stage I, II, and IV disease. In the propensity score-matched sample, splenectomy group also showed significantly worse overall survival (5-year, 65% vs. 79%, p = 0.010) and disease-free survival (5-year, 55% vs. 72%, p = 0.025) and was an independent poor prognostic factor in a multivariate analysis adjusting TNM stage and other prognostic factors.ConclusionsSplenectomy adversely affects survival, particularly among patients with stage III gastric carcinoma, and should be avoided unless there is direct invasion to the splenic hilum.

Human splenic TER cells: A relevant prognostic factor acting via the artemin‐GFRα3‐ERK pathway in pancreatic ductal adenocarcinoma

“…In addition, spleen tissue samples might be used to better evaluate the prognosis of patients with resectable PDAC. Previous studies have shown conflicting results regarding splenectomy and the survival of patients with malignancies 18‐21 . The spleen usually plays an antitumour role in the initial stage of tumorigenesis.…”

“…Previous studies have shown conflicting results regarding splenectomy and the survival of patients with malignancies. [18][19][20][21] The spleen usually…”

“…Previous studies have shown conflicting results regarding splenectomy and the survival of patients with malignancies. [18][19][20][21] The spleen usually plays an antitumour role in the initial stage of tumorigenesis. In an orthotropic murine model of PDAC, splenectomy at the time of tumour inoculation reduced the ratio of tumour-infiltrating CD4+/FoxP3+ cells and CD8+/FoxP3+ cells, which was associated with aggressive tumour growth.…”

Oncologic outcomes after splenectomy during initial cytoreductive surgery in advanced epithelial ovarian cancer: a nationwide population‐based cohort study

“…However, there is limited knowledge about the impact of splenectomy on the long‐term outcome of patients. It has been hypothesized that as the antitumor immunologic functions of the spleen may inhibit cancer growth, splenectomy may promote the growth of residual disease during the postoperative period as observed in murine models of other cancer types 3–6 7 …”

The Retropancreatic Fusion Fascia Oriented Splenic Hilar Lymphadenectomy Versus Laparoscopic Approach In D2 Total Gastrectomy

“…Synchronous splenectomy used to be the consensus to assure LN dissection, regardless of the tumor location and depth. Nevertheless, sufficient evidence has documented the unsatisfactory postoperative outcomes [ 11 , 12 ]. The JCOG 0110 trial also concluded that the 5-year survival rate was comparable between the splenectomy and the spleen preservation groups [ 13 ].…”