title: Prognostic significance of splenic hilar nodal involvement in proximal third gastric carcinoma.
abstract: OBJECTIVE
  The utility of prophylactic splenectomy in patients with proximal third gastric carcinoma is controversial. In this study, we investigated the significance of nodal involvement in the splenic hilum and the impact of splenectomy.
  
  
  METHODS
  A total of 129 patients who underwent D2 radical resection with splenectomy for gastric carcinoma involving the upper portion of the stomach were analyzed.
  
  
  RESULTS
  Lymph node metastasis at the splenic hilum was found in 21 (16.3%) of 129 cases. Multivariate analysis revealed that the number of metastatic lymph nodes was an independent risk factor for lymph node metastasis at the splenic hilum. The 5-year survival rate for patients with lymph node metastasis at the splenic hilum was 17.9%. There were significant differences in survival among patients grouped according to the extent of extraperigastric nodal involvement. While nodal involvement in the splenic hilum was found to be an independent prognostic factor, the number of metastatic lymph nodes was not.
  
  
  CONCLUSIONS
  The prognosis of patients with lymph node metastasis at the splenic hilum was significantly poorer compared to that for patients with metastases in the other extraperigastric nodes. Furthermore, prophylactic splenectomy appears not to improve survival of patients with proximal third gastric carcinoma.
authors.affiliation: Department of Surgery, Nara Medical University, Nara, Japan. t-taka@naramed-u.ac.jp
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Takayama
authors.forename: Kohei
authors.initials: K
authors.lastname: Wakatsuki
authors.forename: Sohei
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Koji
authors.initials: K
authors.lastname: Enomoto
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanaka
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Migita
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nakajima
mesh_terms: D000368:Aged; D002423:Cause of Death; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013154:Spleen / Q000473:pathology*; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate