Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer

Abstract

These results do not support the use of prophylactic splenectomy to remove macroscopically negative lymph nodes near the spleen in patients undergoing total gastrectomy for proximal gastric cancer.

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

“…Csendes et al [26] conducted an RCT comparing extended lymphadenectomy with and without splenectomy, and found that despite some increase in postoperative complications, there was no difference in operative mortality or overall 5-year survival. Similar results were found in the RCT by Yu et al [28], with no statistically significant difference in operative mortality or overall 5-year survival, despite an increase in some complications. Both RCTs showed a trend towards increased overall 5-year survival with resection of the spleen.…”

“…1). Of these, 3 studies were RCTs comparing standard D2 lymphadenectomy with spleenpreserving D2 lymphadenectomy [26,28,30] (Table 1), 1 was an RCT comparing standard D2 lymphadenectomy with pancreas-preserving D2 lymphadenectomy [27] ( Table 1), 6 were prospective studies examining the extent of lymphadenectomy [1,2,9,10,34,35] (Table 2), and 32 were retrospective studies [7, 8, 11, 12, 14-19, 21-23, 29, 36-51] (Table 3). The four RCTs examining spleen and/or pancreas preservation were evaluated and given Jadad scores between 1 and 3 ( Table 1).…”

“…In the RCTs, there was no statistically significant difference between overall survival in patients who underwent extended lymphadenectomy with or without spleen preservation [26,28,30] (Table 1). A forest plot illustrates the meta-analysis of overall survival of the three RCTs comparing gastrectomy with spleen resection or preservation, and demonstrates no statistically significant difference (OR 0.97, 95% CI 0.56-1.68) (Fig.…”

“…Preservation of the spleen and pancreas during D2 lymphadenectomy has been advocated by the authors of the DGCT-recommendations that were made on the basis of post-hoc subgroup analysis and must be interpreted accordingly [24]. Despite assertions from both trials that resection of the spleen and pancreas in the D2 arm was responsible for increased operative morbidity and mortality, no RCT has shown a survival advantage when performing pancreas-preserving or spleen-preserving D2 resection compared to the traditional D2 resection [26][27][28]. In addition, the role of the spleen in cancer immunology has been cited as a reason to consider spleen preservation during extended lymphadenectomy [12].…”

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

“…In these randomized trials from Chile [8], Korea [9], and Japan [10], researchers reported no survival benefit from splenectomy in patients with a total gastrectomy, whereas morbidity was increased. A meta-analysis of operative survival with the data from these randomized trials showed no statistically significant difference (OR, 1.59; 95 % CI, 0.44-5.79) [11].…”