Differential effects of radical D2-lymphadenectomy and splenectomy in surgically treated gastric cancer patients.
OBJECTIVE
Radical surgery with extended lymph node dissection (D2-LA) is the treatment of choice for gastric cancer patients in Japan. In Western countries results after D2-LA are controversially discussed, as increased D2-LA related complications are reported. The aim of this retrospective study was to analyze the influence of D2-LA and/or splenectomy on the clinical course, morbidity and long-term survival of gastric cancer patients.


METHODS
Included in this series are 243 consecutively treated gastric cancer patients with a median age of 63.8 years.


RESULTS
Though 56% of the patients presented with stage III and IV tumors, a resection rate of 95.5% with R0-resections in 73.7% was achieved. D2-LA rate was 66.3% with simultaneous splenectomy in 48.7%. Global morbidity was 41.6%. Surgical morbidity, leakage and abscess rates after curative R0 resections were not influenced by D2-LA (22.5/6.5/6.5% vs. 21.9/9.1/3.0% +/- LA) but by splenectomy (31.6/13.2/11.8% vs. 14.7/2.1/1% +/- Sx). Simultaneous splenectomy was associated with 7 of 9 leakages, 7 of 9 abscesses, and 4 of 5 cases with postoperative pancreatitis. Long-term survival (Kaplan-Meier) was 40.6% for all, and 58.1% for R0 resected patients. It was not influenced by splenectomy (56/60.3% +/- Sx).


CONCLUSIONS
Radical D2-LA has no impact on the morbidity of gastric cancer patients, but splenectomy is always linked with elevated complications without improving survival rates. Therefore splenectomy as potential part of D2-LA can only be advocated in patients with direct infiltration of pancreas or spleen, in stage IV or whenever metastatic spread is supposed in the nodes along splenic artery or hilum.
Schmid
A
A
Department of General & Thoracic Surgery, University of Kiel, Germany.
Thybusch
A
A
Kremer
B
B
Henne-Bruns
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D018530:Gastric Stump; D017052:Hospital Mortality; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012086:Reoperation; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate