Indication of splenectomy for gastric carcinoma involving the proximal part of the stomach.
OBJECTIVE
The role of splenectomy in the surgical management of gastric carcinoma is controversial and there is no consensus of opinion regarding the therapeutic value of splenectomy. The aim of this study was to search for possible metastasis to lymph nodes in the splenic hilum or along the splenic artery to avoid unnecessary splenectomy and to determine its indication.


METHODS
The clinical records of 204 patients who underwent total gastrectomy combined with splenectomy for gastric carcinomas involving the proximal part of the stomach were analyzed.


RESULTS
The incidence of nodal involvement to the splenic hilum and/or along the splenic artery was 49 (24.0%) of 204 gastric carcinomas involving the proximal part of the stomach that underwent combined gastrectomy and splenectomy. The characteristics of gastric carcinoma with metastasis to these nodes included a larger tumor, deeper penetration (T3, 4 tumors), a number of lymph node metastasis, and infiltrative type. In T2 cases, all the tumors with cancerous involvement to these nodes showed intraoperative gross serosal change). When the tumor size was less than 40 mm, nodal metastatic rate to the splenic hilum and/or along the splenic artery was very low.


CONCLUSIONS
In conclusion, splenectomy should be conducted in T2 cases with gross serosal change and T3, 4 cases. With regard to tumor size, in the cases with a tumor whose size was less than 40 mm, it is possible to preserve the spleen in most cases. In the near future, splenectomy should be clarified precisely by randomized trials in advanced gastric carcinoma.
Sakaguchi
T
T
First Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 634-8522, Japan.
Sawada
H
H
Yamada
Y
Y
Fujimoto
H
H
Emoto
K
K
Takayama
T
T
Ueno
M
M
Nakajima
Y
Y
D000231:Adenocarcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D013154:Spleen / Q000473:pathology; D013156:Splenectomy; D013157:Splenic Artery / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*