Is Splenectomy Necessary or Beneficial in Curative Surgery of Gastric Cancer?
Chairat Supsamutchai MD*, Teerawut Rakchob MD*, Pitichote Hiranyatheb MD*, Chuleeporn Jiarpinitnun MD**, Nuttapong Ngamphaiboon MD***, Pattawia Choikrua BSc*
Affiliation : * Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ** Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand *** Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Gastrectomy with D2 lymphadenectomy is a standard treatment of gastric cancer in Japan and Korea.
Splenectomy in gastric cancer surgery has no clear benefits for removing lymph nodes unless it is removing the metastasis of
the lymph nodes at the splenic hilum (Group 10).
Objective : Report the outcome of post gastrectomy with or without splenectomy, together with the effects on lymph node
metastasis, including lymph nodes at the splenic hilum and examined lymph nodes.
Material and Method: A retrospective chart review was made of all patients who presented with gastric cancer after curative
surgery resection between January 1, 2006 and December 31, 2016 at Ramathibodi Hospital, Bangkok, Thailand. Comparisons
were made between the non-splenectomy group and the splenectomy group.
Results : Seventy patients were included in the non-splenectomy group and 35 patients were included in the splenectomy group.
The data including age, gender, histologic type, location of cancer, and TMN staging showed no statistical difference between
the groups. For the lymph node Group 10 metastasis, the number of lymph nodes dissected and lymph node metastasis
showed no statistical significance in both groups (p-value = 0.524 and 0.160 respectively). The rate of lymph node Group 10
metastasis was 6.25%, which was found in the splenectomy group. The data showed that the patients in the splenectomy group
had more dissected lymph nodes than the non-splenectomy group (p-value = 0.0004). Conversely, the lymph node metastasis
in both groups showed no statistical difference (p-value = 0.925). The median follow-up time was 59.51 months. The
recurrence rate, metastasis rate, and overall survival showed no statistical difference in both groups. The five years’ survival
in the non-splenectomy group was 44.88 months and the splenectomy group was 53.75 months (p-value = 0.9368).
Conclusion : In most cases, curative gastric resection with D2 lymphadenectomy is an adequate treatment for gastric cancer.
Unnecessary splenectomy does not benefit overall survival.
Keywords : Splenectomy, Non-splenectomy, Curative resection, Total gastrectomy, Subtotal gastrectomy
