Indication of Splenectomy in Radical Resection for Advanced Proximal Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CUI Chao ,  SUN Libo , SHU Zhenbo , LI Yongchao , DING Dayong , FENG Ye , GAI Baodong , JIN YinZhi , ZHAO Jisheng , ZHENG Zelin

Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China;

Corresponding author：

SUN Libo, Email: sunlibo0431@sina.com

Keywords：

Proximal gastric cancer; Radical resection; Splenectomy; Indication

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the reasonable indication of splenectomy in radical resection for advanced proximal gastric cancer (APGC).
Methods Fifty patients with APGC were studied and classified into total gastrectomy with splenectomy (TGS) group (n=18) and total gastrectomy without splenectomy (TG) group (n=32). The operation time, hospitalized duration, complications, and lymphe node metastasis at the spleen hilus were compared between two groups. Results The operation time, hospitalized duration and subphrenic infection rate in the TGS group were significantly higher than those in the TG group (P lt;0.05). The rate of lymph node metasitasis of No.10 and No.11 in the TG group was not different from that in TGS group (P gt;0.05).
Conclusion Direct spleen and its vessel invasion are the reasonable indication of splenectomy in radical resection for APGC.

Citation： CUI Chao,SUN Libo,SHU Zhenbo,LI Yongchao,DING Dayong,FENG Ye,GAI Baodong,JIN YinZhi,ZHAO Jisheng,ZHENG Zelin. Indication of Splenectomy in Radical Resection for Advanced Proximal Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(1): 22-24. doi: Copy

1.	孙立波, 李永超, 冯野, 等. 全胃切除术后改良Orr式RouxenY 食管空肠吻合术的临床研究 [J]. 中国普外基础与临床杂志, 2008; 15(12): 917919.
2.	Okinaga K, Iinuma H, Kitamura Y, et al. Effect of immunotherapy and spleen preservation on immunological function in patients with gastric cancer [J]. J Exp Clin Cancer Res, 2006; 25(3): 339349.
3.	Noma K, Yamaguchi Y, Okita R, et al. The spleen plays an immunosuppressive role in patients with gastric cancer: involvement of CD62L+ cells and TGFbeta [J].Anticancer Res, 2005; 25(1B): 643649.
4.	Nanthakumaran S, Fernandes E, Thompson AM, et al. Morbidity and mortality rates following gastric cancer surgery and contiguous organ removal, a population based study [J]. Eur J Surg Oncol, 2005; 31(10): 11411144.
5.	Biffi R, Chiappa A, Luca F, et al. Extended lymph node dissection without routine splenopancreatectomy for treatment of gastric cancer: low morbidity and mortality rates in a single center series of 250 patients [J]. J Surg Oncol. 2006; 93(5): 394400.
6.	Fatouros M, Roukos DH, Lorenz M, et al. Impact of spleen preservation in patients with gastric cancer [J]. Anticancer Res, 2005; 25(4): 30233030.
7.	Zhang CH, Zhan WH, He YL, et al. Spleen preservation in radical surgery for gastric cardia cancer [J]. Ann Surg Oncol, 2007; 14(4): 13121319.
8.	Shen JG, Cheong JH, Hyung WJ, et al. Adverse effect of splenectomy on recurrence in total gastrectomy cancer patients with perioperative transfusion [J]. Am J Surg, 2006; 192(3): 301305.
9.	Kunisaki C, Makino H, Suwa H, et al. Impact of splenectomy in patients with gastric adenocarcinoma of the cardia [J]. J Gastrointest Surg, 2007; 11(8): 10391044.
10.	Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer [J]. Br J Surg, 2006; 93(5): 559563.
11.	Kunisaki C, Shimada H, Ono H, et al. Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach [J]. J Gastrointest Surg, 2006; 10(1): 132137.
12.	McCulloch P, Niita ME, Kazi H, et al. Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer [J]. Br J Surg, 2005; 92(1): 513.
13.	Kikuchi S, Nemoto Y, Natsuya K, et al. Which patients with advanced, proximal gastric cancer benefit from complete clearance of splenopancreratic lymph nodes [J]. Anticancer Res, 2002; 22(6B): 35133517.
14.	Weitz J, Jaques DP, Brennan M, et al. Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer [J]. Ann Surg Oncol, 2004; 11(7): 682689.
15.	Yamamoto M, Baba H, Kakeji Y, et al. Postoperative morbidity/mortality and survival rates after total gastrectomy, with splenectomy/pancreaticosplenectomy for patients with advanced gastric cancer [J]. Hepatogastroenterology, 2004; 51(55): 298302.
16.	Ohno M, Nakamura T, Ajiki T, et al. Procedure for lymph node dissection around splenic artery in proximal gastric cancer [J]. Hepatogastroenterology, 2003; 50(52): 11731177.
17.	Carboni F, Lepiane P, Santoro R, et al. Extended multiorgan resection for T4 gastric carcinoma: 25year experience [J]. J Surg Oncol, 2005; 90(2): 95100.
18.	Ikeguchi M, Kaibara N. Lymph node metastasis at the splenic hilum in proximal gastric cancer [J]. Am Surg, 2004; 70(7): 645648.
19.	Csendes A, Burdiles P, Rojas J, et al. A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma [J]. Surgery, 2002; 131(4): 401407.
20.	Bisharat N, Omari H, Lavi L, et al. Risk of infection and death among postsplenectomy patients [J]. J Infect, 2001; 43(3): 182186.
21.	Yang K, Chen XZ, Hu JK, et al. Effectiveness and safety of splenectomy for gastric carcinoma: a metaanalysis [J]. World J Gastroenterol, 2009; 15(42): 53525359.
22.	Sasada S, Ninomiya M, Nishizaki M, et al. Frequency of lymph node metastasis to the splenic hilus and effect of splenectomy in proximal gastric cancer [J]. Anticancer Res, 2009; 29(8): 33473351.
23.	Oh SJ, Hyung WJ, Li C, et al. The effect of spleenpreserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer [J]. J Surg Oncol, 2009; 99(5): 275280.
24.	何运胜, 姜淮芜. 进展期胃癌多模式治疗的研究进展 [J]. 中国普外基础与临床杂志, 2008; 15(1): 3135.
25.	胡建昆, 陈志新, 张波, 等. 胃癌根治术中No. 8 淋巴结清扫的意义和技巧 [J]. 中国普外基础与临床杂志, 2007; 14(5): 560563.

1. 孙立波, 李永超, 冯野, 等. 全胃切除术后改良Orr式RouxenY 食管空肠吻合术的临床研究 [J]. 中国普外基础与临床杂志, 2008; 15(12): 917919.
2. Okinaga K, Iinuma H, Kitamura Y, et al. Effect of immunotherapy and spleen preservation on immunological function in patients with gastric cancer [J]. J Exp Clin Cancer Res, 2006; 25(3): 339349.
3. Noma K, Yamaguchi Y, Okita R, et al. The spleen plays an immunosuppressive role in patients with gastric cancer: involvement of CD62L+ cells and TGFbeta [J].Anticancer Res, 2005; 25(1B): 643649.
4. Nanthakumaran S, Fernandes E, Thompson AM, et al. Morbidity and mortality rates following gastric cancer surgery and contiguous organ removal, a population based study [J]. Eur J Surg Oncol, 2005; 31(10): 11411144.
5. Biffi R, Chiappa A, Luca F, et al. Extended lymph node dissection without routine splenopancreatectomy for treatment of gastric cancer: low morbidity and mortality rates in a single center series of 250 patients [J]. J Surg Oncol. 2006; 93(5): 394400.
6. Fatouros M, Roukos DH, Lorenz M, et al. Impact of spleen preservation in patients with gastric cancer [J]. Anticancer Res, 2005; 25(4): 30233030.
7. Zhang CH, Zhan WH, He YL, et al. Spleen preservation in radical surgery for gastric cardia cancer [J]. Ann Surg Oncol, 2007; 14(4): 13121319.
8. Shen JG, Cheong JH, Hyung WJ, et al. Adverse effect of splenectomy on recurrence in total gastrectomy cancer patients with perioperative transfusion [J]. Am J Surg, 2006; 192(3): 301305.
9. Kunisaki C, Makino H, Suwa H, et al. Impact of splenectomy in patients with gastric adenocarcinoma of the cardia [J]. J Gastrointest Surg, 2007; 11(8): 10391044.
10. Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer [J]. Br J Surg, 2006; 93(5): 559563.
11. Kunisaki C, Shimada H, Ono H, et al. Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach [J]. J Gastrointest Surg, 2006; 10(1): 132137.
12. McCulloch P, Niita ME, Kazi H, et al. Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer [J]. Br J Surg, 2005; 92(1): 513.
13. Kikuchi S, Nemoto Y, Natsuya K, et al. Which patients with advanced, proximal gastric cancer benefit from complete clearance of splenopancreratic lymph nodes [J]. Anticancer Res, 2002; 22(6B): 35133517.
14. Weitz J, Jaques DP, Brennan M, et al. Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer [J]. Ann Surg Oncol, 2004; 11(7): 682689.
15. Yamamoto M, Baba H, Kakeji Y, et al. Postoperative morbidity/mortality and survival rates after total gastrectomy, with splenectomy/pancreaticosplenectomy for patients with advanced gastric cancer [J]. Hepatogastroenterology, 2004; 51(55): 298302.
16. Ohno M, Nakamura T, Ajiki T, et al. Procedure for lymph node dissection around splenic artery in proximal gastric cancer [J]. Hepatogastroenterology, 2003; 50(52): 11731177.
17. Carboni F, Lepiane P, Santoro R, et al. Extended multiorgan resection for T4 gastric carcinoma: 25year experience [J]. J Surg Oncol, 2005; 90(2): 95100.
18. Ikeguchi M, Kaibara N. Lymph node metastasis at the splenic hilum in proximal gastric cancer [J]. Am Surg, 2004; 70(7): 645648.
19. Csendes A, Burdiles P, Rojas J, et al. A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma [J]. Surgery, 2002; 131(4): 401407.
20. Bisharat N, Omari H, Lavi L, et al. Risk of infection and death among postsplenectomy patients [J]. J Infect, 2001; 43(3): 182186.
21. Yang K, Chen XZ, Hu JK, et al. Effectiveness and safety of splenectomy for gastric carcinoma: a metaanalysis [J]. World J Gastroenterol, 2009; 15(42): 53525359.
22. Sasada S, Ninomiya M, Nishizaki M, et al. Frequency of lymph node metastasis to the splenic hilus and effect of splenectomy in proximal gastric cancer [J]. Anticancer Res, 2009; 29(8): 33473351.
23. Oh SJ, Hyung WJ, Li C, et al. The effect of spleenpreserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer [J]. J Surg Oncol, 2009; 99(5): 275280.
24. 何运胜, 姜淮芜. 进展期胃癌多模式治疗的研究进展 [J]. 中国普外基础与临床杂志, 2008; 15(1): 3135.
25. 胡建昆, 陈志新, 张波, 等. 胃癌根治术中No. 8 淋巴结清扫的意义和技巧 [J]. 中国普外基础与临床杂志, 2007; 14(5): 560563.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Indication of Splenectomy in Radical Resection for Advanced Proximal Gastric Cancer

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