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Is Prophylactic Splenectomy Necessary for Proximal Advanced Gastric Cancer Invading the Greater Curvature with Clinically Negative Splenic Hilar Lymph Node Metastasis? A Multi-Institutional Cohort Study (YCOG2003)

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Prophylactic splenectomy for hilar lymph node (#10) dissection has shown no survival benefit for patients with proximal advanced gastric cancer that does not invade the greater curvature. However, the survival benefit of prophylactic splenectomy for proximal advanced gastric cancer invading the greater curvature side, particularly for clinically negative #10 lymph node metastasis (#10[–]) cases remains controversial.

Methods

This multi-institutional retrospective study enrolled 146 consecutive patients with proximal advanced gastric cancers invading the greater curvature side with clinical #10(–) who underwent R0 total gastrectomy. For 33 of these patients, splenectomy was performed, and the remaining 113 underwent spleen–preservation gastrectomy. Short- and long-term results were compared between the splenectomy and spleen-preservation groups, with the incidence of #10 metastasis in the splenectomy group and recurrence in the spleen-preservation group compared.

Results

In the splenectomy group, longer operative time, greater blood loss, more frequent postoperative abdominal infection, and longer hospital stay were observed than in the spleen-preservation group. The two groups exhibited no differences in median relapse-free survival time (31.1 vs 59.8 months; P = 0.684) or median overall survival time (64.9 vs 65.1 months; P = 0.765). The pathologic #10 lymph node metastasis rate was 3% in the splenectomy group, and the #10 lymph node recurrence rate was 2.7% in the spleen-preservation group.

Conclusions

Prophylactic splenectomy showed more frequent postoperative morbidities and a longer hospital stay than spleen preservation, without any long-term survival benefits.

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Acknowledgments

This work was not supported by any financial assistance grants.

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Authors and Affiliations

  1. Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama City, Kanagawa, Japan

    Sho Sato MD, PhD, Chikara Kunisaki MD, PhD, Hiroki Kondo MD & Nobuhiro Tsuchiya MD, PhD

  2. Department of Gastroenterological surgery, Yokohama Municipal Citizen’s Hospital, Yokohama City, Kanagawa, Japan

    Yusaku Tanaka MD & Masazumi Takahashi MD, PhD

  3. Department of Surgery, Yokohama City Minato Red Cross Hospital, Yokohama City, Kanagawa, Japan

    Kei Sato MD, PhD

  4. Department of Surgery, National Hospital Organization Yokohama Medical Center, Yokohama City, Kanagawa, Japan

    Jun Kimura MD, PhD

  5. Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka City, Japan

    Hidetaka A. Ono MD, PhD

  6. Department of Surgery, Fujisawa City Hospital, Fujisawa City, Japan

    Hirochika Makino MD, PhD

  7. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama City, Kanagawa, Japan

    Yuko Tamura MD, Kohei Kasahara MD, Takashi Kosaka MD, PhD, Hirotoshi Akiyama MD, PhD & Itaru Endo MD, PhD

Authors
  1. Sho Sato MD, PhD
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  2. Chikara Kunisaki MD, PhD
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  3. Hiroki Kondo MD
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  4. Nobuhiro Tsuchiya MD, PhD
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  5. Yusaku Tanaka MD
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  6. Masazumi Takahashi MD, PhD
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  7. Kei Sato MD, PhD
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  8. Jun Kimura MD, PhD
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  9. Hidetaka A. Ono MD, PhD
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  10. Hirochika Makino MD, PhD
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  11. Yuko Tamura MD
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  12. Kohei Kasahara MD
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  13. Takashi Kosaka MD, PhD
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  14. Hirotoshi Akiyama MD, PhD
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  15. Itaru Endo MD, PhD
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Corresponding author

Correspondence to Chikara Kunisaki MD, PhD.

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Sato, S., Kunisaki, C., Kondo, H. et al. Is Prophylactic Splenectomy Necessary for Proximal Advanced Gastric Cancer Invading the Greater Curvature with Clinically Negative Splenic Hilar Lymph Node Metastasis? A Multi-Institutional Cohort Study (YCOG2003). Ann Surg Oncol 29, 5885–5891 (2022). https://doi.org/10.1245/s10434-022-11939-w

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  • DOI: https://doi.org/10.1245/s10434-022-11939-w

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