Impact of splenectomy on surgical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction

Pultrum, Bareld B.; Bastelaar, James van; Schreurs, Liesbeth; Dullemen, van Hendrik; Groen, Henk; Nijsten, Maarten W. N.; Dam, van Gooitzen; Plukker, John

doi:10.1111/j.1442-2050.2007.00762.x

Cited by 5 publications

(15 citation statements)

References 34 publications

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“…Based on these previous findings, the prognostic effect of BTF in gastric cancer patients remains unclear. The surgical procedure for EGJ carcinoma may be more complex than that for gastric cancer, because of its approach or the extent of lymphadenectomy, and BTF for excessive IBL may thus be more common during surgery for EJG carcinoma compared with gastric cancer (20). However, our current results suggest that BTF for excessive IBL associated with complex surgery, in addition to splenectomy, may lead to poor outcomes in patients with ECJ carcinoma.…”

Section: Discussioncontrasting

confidence: 53%

Prognostic Impact of Splenectomy in Patients with Esophagogastric Junction Carcinoma

Fukuchi

Mochiki

Ishiguro

et al. 2018

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Abstract. Background p=0.04) and venous invasion (OR=3.03; p=0.02) The incidence of adenocarcinoma of the oesophagogastric junction (EGJ) is increasing in both Western and Eastern countries (1). The Siewert classification of EGJ adenocarcinomas has been widely accepted (2), while the current classification system in Japan designates a tumor as an EGJ carcinoma, regardless of its histological type, when its epicentre is located within 2 cm proximal or distal to the EGJ (3). Moreover, though in these EGJ carcinomas are less than 4 cm in diameter, the algorithm was established to provide a tentative standard for lymphadenectomy based on the results of a retrospective multi-institutional study in Japanese guidelines (4). However, the final results of this study did not alter the recommendations, and the optimal surgical procedures for EGJ carcinoma, including the surgical approach (transthoracic or transhiatal), range of lymphadenopathy and type of gastrectomy remain controversial.The European Society for Medical Oncology clinical practice guidelines recommend D2 gastrectomy for curable gastric cancer. However, splenectomy is not recommended unless the tumor is directly infiltrating the spleen (5, 6). In contrast, Japanese guidelines include splenectomy in D2 total gastrectomy (3). A recent randomised trial reported that splenectomy should be avoided because it increased operative morbidity without improving survival in patients undergoing total gastrectomy for proximal gastric cancer not invading the greater curvature (7). Moreover, a previous study reported that splenic hilar lymph node dissection could be omitted from EGJ carcinoma surgery without decreasing curability, based on the index of estimated benefit from lymph node dissection (8). However, this study did not establish the value of splenectomy or not in patients with EGJ carcinoma.Further information regarding the survival benefits of splenectomy will help determine the optimal surgical procedure in patients with ECJ carcinoma. We retrospectively examined clinicopathological and survival data for surgically treated patients with ECJ carcinoma, to determine the benefits of splenectomy. Patients and MethodsPatients. We retrospectively reviewed a database of 60 patients with EGJ carcinoma who had undergone macroscopically complete resection (R0 or R1) at

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Section: Discussioncontrasting

confidence: 53%

Prognostic Impact of Splenectomy in Patients with Esophagogastric Junction Carcinoma

Fukuchi

Mochiki

Ishiguro

et al. 2018

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“…The incidence of splenectomy during esophagectomy for esophageal cancer ranged from 4 to 9 percent in previous reports (6)(7)(8)(9)(10)(11). This incidence became lower in the more recent reports (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…In the Dutch and British gastric cancer trials, extensive operations with splenectomy was a major factor for complications and was associated with increased morbidity and mortality, reducing the overall survival. Based on this data, many surgeons abandoned this procedure during gastric cancer surgery (10,(13)(14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

“…Splenectomy affects both the humoral and cell mediated immune response, leading to increased risk of infection and diminished capacity in removing tumor micro-metastases (10,12).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, splenectomy may be performed as part of a planned en block resection for better nodal clearance. However, addition of splenectomy led to higher morbidity and mortality rates after operations for various gastrointestinal cancers, particularly in gastric and colonic malignancies (6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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Influence of Splenectomy on Morbidity of Esophageal Cancer Surgery

et al. 2010

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Background and Aim: during esophagectomy, splenic injury may occur due to unintentional operative trauma, caused by excessive traction on the splenic ligaments or misplacement of retractors. the role of spleen in immune system is well recognized and the addition of splenectomy to esophagectomy may increase the rate of complications. the goal of this study was to determine the influence of splenectomy on postoperative morbidity and mortality after esophageal resection for esophageal cancer.Materials and Methods: between January 2001 and april 2006, 420 cases with esophageal cancer underwent esophagectomy in a referral cancer institute. In 14 patients (3.3%) splenectomy was added because of unwanted splenic injury during operation. In-hospital morbidities and mortality and hospital stay were compared between patients with and without concomitant splenectomy.Results: although the overall complication rate in splenectomized patients was higher than other patients (43% vs. 30%), this figure was not statistically significant (p value: 0.3). cervical anastomotic leakage occurred in 35.7% of splenectomized patients in comparison to 12.2% of control group (p value: 0.01, odds ratio: 3.93, cI 95% : 1.27-12.2). there were no significant differences in cardiac and pulmonary complications, and in-hospital mortality rate between patients with and without splenectomy (p value > 0.05). splenectomy did significantly affect post operative hospital stay (19 ± 13 vs. 13 ± 7 days, p value: 0.004).Conclusions: during esophagectomy, unplanned splenectomy may increase the incidence of anastomotic leakage and hospital stay. therefore, whenever possible preservation of the spleen should be considered. an unexpected relationship between splenectomy and anastomotic leaks needs further investigation.

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