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Clinical Significance of Splenic Hilar Dissection with Splenectomy in Advanced Proximal Gastric Cancer: An Analysis at a Single Institution in Japan

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Abstract

Background

Significance of splenic hilar node dissection with splenectomy is now denied for advanced gastric cancer of upper one-third of the stomach without invasion to the greater curvature by the Japan Clinical Oncology Group 0110, a pivotal randomized study from Japan. However, a question remains for tumors which involve the greater curvature, as this study excluded such tumors.

Methods

We retrospectively analyzed 421 consecutive patients with gastric cancer who underwent curative total gastrectomy with splenectomy from 1992 to 2009. The survival curves, state of lymph node (LN) metastasis, and index of the estimated benefit from LN dissection of each station were evaluated according to the tumor location.

Results

The incidence of No. 10 metastasis was 9.3 % (39/421), with 15.9 % in patients with tumors involving the greater curvature (Gre group, n = 132) and 6.2 % in those without (non-Gre group, n = 289) (P = 0.032). The 5-year overall survival (OS) of patients with and without No. 10 metastasis was 35.4 and 43.1 % (P = 0.135) in the Gre group and 32.8 and 66.5 % (P = 0.0006) in the non-Gre group, respectively. The index of No. 10 LN dissection was 5.6 and 2.0 in the Gre and non-Gre groups, respectively. In the Gre group, the index was relatively higher in patients aged < 65 years, within pT3, and with Borrmann type 4 tumors.

Conclusions

Splenectomy may have a survival benefit when a tumor shows involvement with the greater curvature, especially in relatively young patients and those without serosal exposure.

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References

  1. Japanese Gastric Cancer Association (2010) Japanese classification of gastric carcinoma, 14th edn. Kanehara, Tokyo

    Google Scholar 

  2. Japanese Gastric Cancer Association (2010) Gastric cancer treatment guideline 2010, 3rd edn. Kanehara, Tokyo

    Google Scholar 

  3. Okajima K, Isozaki H (1995) Splenectomy for treatment of gastric cancer: Japanese experience. World J Surg 19:537–540. doi:10.1007/BF00294715

    Article  CAS  PubMed  Google Scholar 

  4. Monig SP, Collet PH, Baldus SE et al (2001) Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol 76:89–92

    Article  CAS  PubMed  Google Scholar 

  5. Brady MS, Rogatko A, Dent LL et al (1991) Effect of splenectomy on morbidity and survival following curative gastrectomy for carcinoma. Arch Surg 126:359–364

    Article  CAS  PubMed  Google Scholar 

  6. Kunisaki C, Makino H, Suwa H et al (2007) Impact of splenectomy in patients with gastric adenocarcinoma of the cardia. J Gastrointest Surg 11:1039–1044

    Article  PubMed  Google Scholar 

  7. Kwon SJ, Members of the Korean Gastric Cancer Study Group (1997) Prognostic impact of splenectomy on gastric cancer: results of the Korean Gastric Cancer Study Group. World J Surg 21:837–844. doi:10.1007/s002689900314

    Article  CAS  PubMed  Google Scholar 

  8. Maehara Y, Moriguchi S, Yoshida M et al (1991) Splenectomy does not correlate with length of survival in patients undergoing curative total gastrectomy for gastric cancer. Cancer 67:3006–3009

    Article  CAS  PubMed  Google Scholar 

  9. Bonenkamp JJ, Hermans J, Sasako M et al (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 340:908–914

    Article  CAS  PubMed  Google Scholar 

  10. Cuschieri A, Weeden S, Fielding J (1999) Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 79(9–10):1522–1530

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kosuga T, Ichikawa D, Okamoto K et al (2011) Survival benefits from splenic hilar lymph node dissection by splenectomy in gastric cancer patients: relative comparison of the benefits in subgroups of patients. Gastric Cancer 14:172–177

    Article  PubMed  Google Scholar 

  12. Sasada S, Ninomiya M, Nishizaki M et al (2009) Frequency of lymph node metastasis to the splenic hilus and effect of splenectomy in proximal gastric cancer. Anticancer Res 29:3347–3352

    PubMed  Google Scholar 

  13. Sano T, Yamamoto S, Sasako M (2002) Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma: Japan clinical oncology group study JCOG 0110-MF. Jpn J Clin Oncol 32:363–364

    Article  PubMed  Google Scholar 

  14. Sano T, Sasako M, Mizusawa J, et al (2015) Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma (JCOG0110): final survival analysis. Jpn J Clin Oncol 33 (suppl 3; abstr 103)

  15. Sakuramoto S, Sasako M, Yamaguchi T et al (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357:1810–1820

    Article  CAS  PubMed  Google Scholar 

  16. Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sasako M, McCulloch P, Kinoshita T et al (1995) New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg 82:346–351

    Article  CAS  PubMed  Google Scholar 

  18. Yu W, Choi GS, Chung HY (2006) Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 93:559–563

    Article  CAS  PubMed  Google Scholar 

  19. Zhu G, Sun Z, Wang Z et al (2012) Splenic hilar lymph node metastasis independently predicts poor survival for patients with gastric cancers in the upper and/or the middle third of the stomac. J Surg Oncol 105:786–792

    Article  PubMed  Google Scholar 

  20. Maruyama K, Okabayashi K, Kinoshita K (1987) Progress in gastric surgery in Japan and its limits of radicality. World J Surg 11:418–425. doi:10.1007/BF01655804

    Article  CAS  PubMed  Google Scholar 

  21. Ikeguchi M, Kaibara N (2004) Lymph node metastasis is at the splenic hilum in proximal gastric cancer. Am Surg 70:645–648

    PubMed  Google Scholar 

  22. Aoyagi K, Kouhuji K, Miyagi M et al (2010) Prognosis of metastatic splenic hilum lymph node in patients with gastric cancer after total gastrectomy and splenectomy. World J Hepatol 27:81–86

    Google Scholar 

  23. Nashimoto A, Yabusaki H, Matsui A (2012) The significance of splenectomy for advanced proximal gastric cancer. Int J Surg Oncol. doi:10.1155/2012/301530

    PubMed  PubMed Central  Google Scholar 

  24. Yoshikawa T, Tsuburaya A, Kobayashi O et al (2001) Should scirrhous gastric carcinoma be treated surgically? Clinical experiences with 233 cases and a restrospective analysis of prognosticators. Hepatogastroenterology 48:1509–1512

    CAS  PubMed  Google Scholar 

  25. Kim DY, Kim HR, Kim YJ et al (2002) Clinicopathological features of patients with Borrmann type IV gastric carcinoma. ANZ J Surg 72:739–742

    Article  PubMed  Google Scholar 

  26. Griffith JP, Sue-Ling HM, Martin I et al (1995) Preservation of the spleen improves survival after radial surgery for gastric cancer. Gut 36:684–690

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Bartlett Edmund K, Robert E et al (2014) Morbidity and mortality after total gastrectomy for gastric malignancy using the American College of Surgeons National Surgical Quality Improvement Program database. Surgery 156:298–304

    Article  PubMed  Google Scholar 

  28. Sano T, Sasako M, Shibata T, et al. (2010) Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma (JCOG0110): analyzes of operative morbidity, operation time, and blood loss. J Clin Oncol 28(15s) (suppl; abstr 4020)

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Authors and Affiliations

  1. Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Masahiro Watanabe, Takahiro Kinoshita, Naoki Enomoto, Hidehito Shibasaki & Toshirou Nishida

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  1. Masahiro Watanabe
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  2. Takahiro Kinoshita
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  3. Naoki Enomoto
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  4. Hidehito Shibasaki
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  5. Toshirou Nishida
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Corresponding author

Correspondence to Takahiro Kinoshita.

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The authors have no commercial interest or financial support to disclose in the subject of this study.

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Watanabe, M., Kinoshita, T., Enomoto, N. et al. Clinical Significance of Splenic Hilar Dissection with Splenectomy in Advanced Proximal Gastric Cancer: An Analysis at a Single Institution in Japan. World J Surg 40, 1165–1171 (2016). https://doi.org/10.1007/s00268-015-3362-4

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  • DOI: https://doi.org/10.1007/s00268-015-3362-4

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