Prognostic Impact of Splenectomy in Patients with Esophagogastric Junction Carcinoma

Abstract

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