title: Postoperative morbidity/mortality and survival rates after total gastrectomy, with splenectomy/pancreaticosplenectomy for patients with advanced gastric cancer.
abstract: OBJECTIVE
  Indications for splenectomy in patients with proximal and middle gastric cancer remain controversial. We investigated characteristic findings in patients with lymph node metastasis to the splenic hilus and the indication of splenectomy with total gastectomy for T2 and T3 advanced gastric cancer.
  
  
  METHODS
  Two hundred and forty-one Japanese patients underwent curative operations for T2 and T3 advanced gastric cancer.
  
  
  RESULTS
  The mortality rates were similar, but the morbidity rate for patients who underwent pancreaticosplenectomy was higher than for patients who underwent either total gastrectomy alone or with splenectomy (p<0.007). The rates in cases of lymph node metastasis at the depth of tumor invasion within the subserosa and serosa (T3) were 1.7% and 17.5%, respectively (p<0.003). Lymph node metastasis to the splenic hilus was also evident in patients with T3 or T2 advanced gastric cancer with multiple lymph nodes metastasis (more than 7 nodes). The 10-year survival rates for patients who underwent total gastrectomy alone, with splenectomy, and with pancreaticosplenectomy in T3 advanced gastric cancers were 25%, 42% and 32%, respectively (p=0.184).
  
  
  CONCLUSIONS
  Based on these data, the addition of distal pancreaticosplenectomy to total gastrectomy in patients with T2 and T3 advanced gastric cancer increased the risk of complications. Nevertheless, we recommend that total gastrectomy with splenectomy should be done for patients with T3 advanced gastric cancers [and T2 advanced gastric cancer with multiple lymph nodes metastasis (more than 7 nodes)], recognizing the lymph node metastasis to the splenic hilus.
authors.affiliation: Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan. ik.surg@vesta.ocn.ne
authors.forename: Manabu
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
authors.forename: Kazuya
authors.initials: K
authors.lastname: Endo
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Toh
authors.forename: Shunji
authors.initials: S
authors.lastname: Kohnoe
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okamura
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality*; D011379:Prognosis; D013156:Splenectomy / Q000009:adverse effects / Q000401:mortality*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis