title: Splenic hilar lymph node metastasis independently predicts poor survival for patients with gastric cancers in the upper and/or the middle third of the stomach.
abstract: BACKGROUND
  Effectiveness of splenectomy for advanced gastric cancers occupying the upper and/or the middle third of the stomach is still in debate. The aim of the present study is to elucidate the impact of splenectomy on patient survival by investigating the pathological characteristics and prognostic significance of splenic hilar lymph node metastasis.
  
  
  METHODS
  Clinicopathologic and prognostic data of 265 patients with gastric cancer in the upper and/or the middle third of the stomach who underwent the operation of en bloc resection of primary cancer and D2/D3 lymphadenectomy combined with splenectomy were retrospectively reviewed.
  
  
  RESULTS
  Multivariate analysis revealed pT category, pN category, and distant lymph node metastasis independently correlated with the presence of splenic hilar lymph node metastasis. Prognoses of patients with positive splenic hilar lymph nodes were significantly poorer than that of patients with negative splenic hilar lymph nodes for the entire study population and for those who underwent R0 resection, but not for those who underwent R1-2 resection. There was no significant difference in survival between patients who underwent R0 resection with positive splenic hilar lymph nodes and those who underwent R1-2 resection. Splenic hilar lymph node metastasis was one of independent indicators predicting worse prognosis and the presence of distant metastasis after surgery. Subset analysis according to the TNM stage revealed there were significant differences in survival between patients with and without splenic hilar lymph node metastasis.
  
  
  CONCLUSIONS
  Splenic hilar lymph node metastasis should be considered as one of incurable factors. Consequently, the efficiency of splenectomy aiming at prolonging survival for patients with high risk of splenic hilar lymph nodes metastasis should be questioned, although resection of invasive organs form gastric cancers has been recommended if R0 surgery could be achieved.
authors: Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China.
authors: Guo-Lian
authors: GL
authors: Zhu
authors: Zhe
authors: Z
authors: Sun
authors: Zhen-Ning
authors: ZN
authors: Wang
authors: Ying-Ying
authors: YY
authors: Xu
authors: Bao-Jun
authors: BJ
authors: Huang
authors: Yan
authors: Y
authors: Xu
authors: Zhi
authors: Z
authors: Zhu
authors: Hui-Mian
authors: HM
authors: Xu
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008197:Lymph Node Excision / Q000401:mortality*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D013156:Splenectomy / Q000401:mortality*; D013160:Splenic Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate