title: A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer.
abstract: BACKGROUND
  The overall prognosis and survival of patients with advanced gastric cancer are generally poor. Extended lymphadenectomy is recommended for patients with advanced gastric cancer; however, splenectomy and distal pancreatectomy performed with an extended lymph node dissection may be associated with increased morbidity and mortality.
  
  
  METHODS
  Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 31 December 2009. Studies on gastric carcinoma investigating extended lymphadenectomy with splenectomy and/or pancreaticosplenectomy that reported data on surgical outcomes or survival were selected.
  
  
  RESULTS
  Forty studies were included in this review. Decreased complication rates were demonstrated with spleen preservation in two prospective studies and three retrospective studies, and with pancreas preservation in five retrospective studies. No randomized controlled trial showed survival benefit or detriment for preservation of spleen or pancreas in extended lymphadenectomy. Improved survival was demonstrated with spleen preservation in two prospective and eight retrospective studies, and with pancreas preservation in one prospective and four retrospective studies.
  
  
  CONCLUSIONS
  Preservation of the spleen and pancreas during extended lymphadenectomy for gastric cancer decreases complications with no clear evidence of improvement or detriment to overall survival.
authors.affiliation: Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Suite T2-60, 2075 Bayview Ave, Toronto, ON, M4N-3M5, Canada.
authors.forename: Savtaj S
authors.initials: SS
authors.lastname: Brar
authors.forename: Rajini
authors.initials: R
authors.lastname: Seevaratnam
authors.forename: Roberta
authors.initials: R
authors.lastname: Cardoso
authors.forename: Calvin
authors.initials: C
authors.lastname: Law
authors.forename: Lucy
authors.initials: L
authors.lastname: Helyer
authors.forename: Natalie
authors.initials: N
authors.lastname: Coburn
mesh_terms: D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D010179:Pancreas / Q000473:pathology / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D013154:Spleen / Q000473:pathology / Q000601:surgery; D013156:Splenectomy / Q000379:methods* / Q000401:mortality; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate