Effect of Simultaneous Splenectomy on the Survival of Patients Undergoing Curative Gastrectomy for Proximal Gastric Carcinoma

Abstract

The findings of this retrospective study showed that simultaneous splenectomy had no effect on the survival of patients who underwent curative gastrectomy for gastric carcinoma. Thus, splenectomy may only be appropriate for patients with direct invasion of the spleen.

Discussions on Changes in Gastric Lymph Drainage in Malignant Gastric Pathology in Terms of Intraoperative Lymphography

“…In papillary tumors, the lymphatic metastasis was predominant in the celiac and subpiloric group, as well as in the splenic hilum in 11% of cases. These findings reinforce the importance of retrograde circulation in tumoral gastric surgery [3][4][5]37,[64][65][66][67][68][69][70]. We have found 36% of cases with tumor of the cardia, the presence of subpiloric lymph node metastasis and in 45% lymphatic metastasis in the splenic hilum which highlight the importance of retrograde lymphatic flow in loco regional metastasis [29,71].…”

“…We found it interesting to follow the distribution of lymphatics from the juxta parietal nodes and establish appreciate regrouping its collectors. One could notice a halving of the hepatic lymphatic chain and drainage to be collectors from a relay in gastric coronary nodes and the importance of the posterior gastric artery which sustains the splenic node chain [1,4,24,25,31,32,63,86].…”

“…It is well known that in the early stages of gastric cancer when the malignant process does not exceed the mucosa, the patient being in an ideal therapeutic stage the cancerous proliferation is already accompanied by neoplazic lymphatic embolie. This early lymphatic invasion brings forward the role of the morphology of the lymphatic system in the neoplazic dissemination and in the genesis of metastasis [1][2][3][4][5][6]. Surgeons believe that in the median, only one fifth of the patients with and without systematic lymphadenectomy had positive nodes whereas pathologists found almost three fourths of positive lymph nodes (72,7%) in patients with proximal carcinoma of the stomach as compared to those without systematic lymphadenectomy (30,8%).…”

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

“…Among these studies, three RCT have been reported. In a Chilean single‐institution RCT 29 involving 187 patients, splenectomy showed a slightly better 5‐year overall survival (OS) rate (42% vs 36%), but the difference was not statistically significant. A small Italian single‐institution RCT 30 involving 73 patients excluded those with tumors invading the greater curvature and included only patients with LN‐positive cancer.…”

“…Table 4 summarizes the outcomes of previous studies comparing splenectomy and spleen-preservation surgery. 2,8,[25][26][27][28][29][30][31][32] Most studies did not discriminate patients by the presence of greater curvature invasion. Among these studies, three RCT have been reported.…”