title: [Impact of splenectomy and/or distal pancreatectomy in the prognosis of the proximal gastric cancer].
abstract: OBJECTIVE
  Identify prognostic factors associated to total or proximal gastrectomy with or without splenectomy and / or distal pancreatectomy in patient with proximal gastric cancer. Evaluate the frequency of lymph node metastasis to the hilum and splenic artery, postoperative morbidity and mortality and the impact of lymphadenectomy of group 10 and 11 on long term survival.
  
  
  METHODS
  We performed an observational, descriptive, longitudinal and retrospective study analyzing patients with diagnostic of proximal third gastric adenocarcinoma subjected to total or proximal gastrectomy with or without splenectomy or distal pancreatectomy in the service of Abdomen of the Instituto Nacional de Enfermedades Neoplásicas between 1990 and 2005. Overall survival for each of the groups was calculated using the Kaplan-Meier method, prognostic factors were evaluated using univariate and multivariate analysis.
  
  
  RESULTS
  We studied 219 patients with proximal third gastric adenocarcinoma (cardias and bottom), of wich, according to inclusion criteria, only qualify 129 (N=129): 22 (17.1%) were treated by gastrectomy alone, 79 (61.2%) gastrectomy associated witch splenectomy and 28 (21.7%) gastrectomy with distal pancreatosplenectomy, constituting three treatment groups. We compared the survival of each group and each factor analyzed, determining the following prognostic factors: lymph node metastasis (N2-N3), degree of differentiation, undifferentiated tumors and Borrmann III and IV tumors. Neither splenectomy or distal pancreatectosplenectomy improved survival compared to the gastrectomy alone. The morbidity and mortality was higher in patients with more aggressive but more aggressive surgery without significant value.
  
  
  CONCLUSIONS
  The number of nodes removed in patients who had pancreatosplenectomy and /or splenectomy was higher, however, had no impact on survival at 5 years.
authors.affiliation: Servicio de Cirugía General Especializada y Oncológica, Hospital IV Alberto Sabogal Sologuren, Lima, Perú. edmorig1@hotmail.com
authors.forename: Edmundo
authors.initials: E
authors.lastname: Mori Gonzales
authors.forename: Juan
authors.initials: J
authors.lastname: Celis
authors.forename: Eloy
authors.initials: E
authors.lastname: Ruiz
authors.forename: Eduardo
authors.initials: E
authors.lastname: Payet
authors.forename: Francisco
authors.initials: F
authors.lastname: Berrospi
authors.forename: Iván
authors.initials: I
authors.lastname: Chavez
authors.forename: Frank
authors.initials: F
authors.lastname: Young
authors.forename: Carlos
authors.initials: C
authors.lastname: Luque
authors.forename: Jaime
authors.initials: J
authors.lastname: Montes
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis