title: Impact of splenectomy in patients with gastric adenocarcinoma of the cardia.
abstract: Previous reports have suggested that splenectomy treatment of gastric carcinoma of the cardia results in poor patient outcome, but the reason for this is unclear. This study aimed to clarify the impact of splenectomy for gastric carcinoma patients. A total of 118 patients with gastric carcinoma of the cardia were enrolled in this study. The characteristics of patients with lymph node metastasis at the splenic hilum were determined, and the effects of lymph node dissection or splenectomy on postoperative morbidity, mortality, and pattern of recurrence were evaluated. Advanced tumors were common in patients with lymph node metastasis at the splenic hilum, Siewert type III, greater curvature sites, larger and deeper tumors, multiple metastatic lymph nodes, and high incidences of para-aortic lymph node metastasis frequently observed. The effectiveness of lymph node dissection of the splenic hilum was low and equal to that of dissection of the para-aortic lymph nodes. Postoperative morbidity, as represented by pancreatic fistula, was high following splenectomy or pancreaticosplenectomy, but patient mortality did not occur. Hematogenous metastasis was common, as well as peritoneal metastasis after curative gastrectomy. Splenectomy should be limited in those patients with gastric cardia tumors invading the spleen or with metastatic bulky lymph nodes extending to the spleen.
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. s0714@med.yokohama-cu.ac.jp
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunisaki
authors.forename: Hirochika
authors.initials: H
authors.lastname: Makino
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Suwa
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sato
authors.forename: Takashi
authors.initials: T
authors.lastname: Oshima
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nagano
authors.forename: Syoichi
authors.initials: S
authors.lastname: Fujii
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Akiyama
authors.forename: Masato
authors.initials: M
authors.lastname: Nomura
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Otsuka
authors.forename: Hidetaka A
authors.initials: HA
authors.lastname: Ono
authors.forename: Takashi
authors.initials: T
authors.lastname: Kosaka
authors.forename: Ryo
authors.initials: R
authors.lastname: Takagawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ichikawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D002299:Cardia; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate