title: Spleen preservation in radical surgery for gastric cardia cancer.
abstract: BACKGROUND
  In gastric cardia cancer (GCC), the spleen is usually removed when the tumor is resected. This allows thorough lymph node dissection in the splenic hilus. However, the long-term effect of splenectomy on patient survival is controversial. The purpose of this study was to investigate the effect of spleen preservation on survival following radical resection for gastric cardia cancer.
  
  
  METHODS
  We reviewed the records of 116 GCC patients (Siewert types II and III) who underwent radical resection with D2 or D3 lymphadenectomy between July 1994 and December 2003. Survival status was ascertained in December 2004 and data from 108 patients were analysed. Of these 108 patients, 38 underwent splenectomy and 70 had splenic preservation. Clinicopathological features and prognostic data of the splenectomy(+) and splenectomy(-) groups were compared.
  
  
  RESULTS
  Seventy-four patients (68.5%) had lymph node involvement; 18 (16.7%) had involvement of nodes in the splenic hilus. Postoperative morbidity in the two groups was similar. Overall 5-year survival was higher in the splenectomy(-) group than the splenectomy(+) group (38.7% versus 16.9%, P =.008). Multivariate regression indicated that tumor invasion (P =.009) and lymph node metastasis (P = .001) were independent prognostic factors--they predicted decreased survival--with or without splenectomy. Although splenectomy was be associated with lower survival, it was not an independent prognostic factor (P =.085).
  
  
  CONCLUSIONS
  Splenectomy does not improve survival of patients who undergo curative resection for gastric cardia cancer. Thus, the spleen should be preserved in patients without direct cancer invasion of the spleen.
authors.affiliation: Department of Gastrointestinopancreatic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080 Guangdong Province, People's Republic of China.
authors.forename: Chang-Hua
authors.initials: CH
authors.lastname: Zhang
authors.forename: Wen-Hua
authors.initials: WH
authors.lastname: Zhan
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: He
authors.forename: Chuang-Qi
authors.initials: CQ
authors.lastname: Chen
authors.forename: Mei-Jin
authors.initials: MJ
authors.lastname: Huang
authors.forename: Shi-Rong
authors.initials: SR
authors.lastname: Cai
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D002299:Cardia; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013154:Spleen / Q000502:physiology*; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome