Effectiveness and safety of splenectomy for gastric carcinoma: a meta-analysis.
OBJECTIVE
To evaluate the impact of splenectomy on long-term survival, postoperative morbidity and mortality of patients with gastric cancer by performing a meta-analysis.


METHODS
A search of electronic databases to identify randomized controlled trials in The Cochrane Library trials register, Medline, CBMdisc (Chinese Biomedical Database) and J-STAGE, etc was performed. Data was extracted from the studies by 2 independent reviewers. Outcome measures were survival, postoperative morbidity and mortality and operation-related events. The meta-analyses were performed by RevMan 4.3.


RESULTS
Three studies comprising 466 patients were available for analysis, with 231 patients treated by gastrectomy plus splenectomy. Splenectomy could not increase the 5-year overall survival rate [RR=1.17, 95% confidence interval (CI) 0.97-1.41]. The postoperative morbidity (RR=1.76, 95% CI 0.82-3.80) or mortality (RR=1.58, 95% CI 0.45-5.50) did not suggest any significant differences between the 2 groups. No significant differences were noted in terms of number of harvested lymph nodes, operation time, length of hospital stay and reoperation rate. Subgroup analyses showed splenectomy did not increase the survival rate for proximal and whole gastric cancer. No obvious differences were observed between the 2 groups when stratified by stage. Sensitivity analyses indicated no significant differences regarding the survival rates (P>0.05).


CONCLUSIONS
Splenectomy did not show a beneficial effect on survival rates compared to splenic preservation. Routinely performing splenectomy should not be recommended.
Yang
Kun
K
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China.
Chen
Xin-Zu
XZ
Hu
Jian-Kun
JK
Zhang
Bo
B
Chen
Zhi-Xin
ZX
Chen
Jia-Ping
JP
D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008207:Lymphatic Metastasis; D009017:Morbidity; D009362:Neoplasm Metastasis; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*