title: The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer.
abstract: BACKGROUND
  The aim of this study was to investigate the effects of D2 lymphadenectomy with spleen preservation on surgical outcomes in locally advanced proximal gastric cancer.
  
  
  METHODS
  Between January 2000 and December 2004, a total of 366 patients who underwent curative total gastrectomy were studied retrospectively from a prospectively designed database.
  
  
  RESULTS
  The spleen-preservation group experienced shorter operation times, a lower incidence of perioperative transfusion, and shorter postoperative hospital stays. Perioperative transfusion and splenectomy were independent risk factors for morbidity. There was no significant difference between the two groups in recurrence or cumulative survival rate when adjusted according to cancer stage. Multivariate analysis showed that tumor size, serosal invasion, and nodal metastasis were independent prognostic factors, while splenectomy was not. The cumulative survival rate in pN0-status patients was significantly higher in the spleen-preservation group, while there was no significant difference in the survival of pN1- or pN2-status patients between the two groups.
  
  
  CONCLUSIONS
  Splenectomy for lymph node dissection in proximal gastric cancer patients obviously showed poor short-surgical outcomes, but it did not affect long-term outcomes in terms of recurrence and overall survival rate. Therefore, spleen-preserving lymphadenectomy is a feasible method for radical surgery in locally advanced proximal gastric cancer.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seodaemun-Gu, Seoul, South Korea.
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Oh
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.forename: Chen
authors.initials: C
authors.lastname: Li
authors.forename: Jyewon
authors.initials: J
authors.lastname: Song
authors.forename: Wookho
authors.initials: W
authors.lastname: Kang
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Rha
authors.forename: Hyun Cheol
authors.initials: HC
authors.lastname: Chung
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D013154:Spleen; D013156:Splenectomy / Q000009:adverse effects / Q000401:mortality; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome