title: Survival benefits from splenic hilar lymph node dissection by splenectomy in gastric cancer patients: relative comparison of the benefits in subgroups of patients.
abstract: BACKGROUND
  The present study estimated survival benefits from lymph node dissection at the splenic hilus in advanced proximal gastric cancer patients who underwent total gastrectomy with simultaneous splenectomy, and then determined patient subgroups that received relatively high survival benefits from splenectomy.
  
  
  METHODS
  A total of 280 patients with advanced proximal gastric cancer who underwent curative total gastrectomy with simultaneous splenectomy were retrospectively analyzed. Patients with primary tumors directly invading the spleen or pancreas and those with gross metastases to the para-aortic nodes, as determined by intraoperative diagnosis, were excluded from analyses. The index of estimated benefit from lymph node dissection at the splenic hilus by splenectomy was calculated for each clinicopathological factor by multiplying the incidence of splenic hilar metastasis by the 5-year survival rate of patients with metastasis to that nodal station.
  
  
  RESULTS
  Thirty patients (10.7%) showed lymph node metastasis at the splenic hilus, and the 5-year survival rate of these patients was 51.3% (overall index 5.49). The index was relatively high in patient subgroups with tumors localized on the greater curvature (19.4) and Borrmann type 4 cancers (12.9), while relatively low in subgroups with encircling tumors (1.62) and tumors invading adjacent organs other than the spleen and pancreas (0).
  
  
  CONCLUSIONS
  Patients with tumors localized on the greater curvature and Borrmann type 4 cancers might obtain relatively high survival benefits from lymph node dissection at the splenic hilus by splenectomy.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kosuga
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000401:mortality; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013154:Spleen / Q000601:surgery; D013156:Splenectomy / Q000401:mortality*; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*