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Is Splenic Hilar Lymph Node Dissection Without Splenectomy Essential for Proximal Advanced Gastric Cancer?

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

Abstract

Background

The standard surgery for proximal advanced gastric cancer (PAGC) is total gastrectomy with D2 lymph node dissection (LND). Although prophylactic splenectomy for splenic hilar LND (No. 10) is not recommended due to any survival advantage, prophylactic LND (No. 10) without splenectomy remains controversial. Thus, we aimed to evaluate whether No. 10 LND is essential for patients’ survival benefit in PAGC.

Methods

We conducted a retrospective study of 1038 patients with PAGC who underwent total gastrectomy without splenectomy. After adjusting for confounders and propensity score matching (PSM), patients were grouped into Group 1 (D2 LND without splenic hilar LN; n = 288) or Group 2 (D2 LND with splenic hilar LN; n = 288). Variables between the two groups (5-year overall survival [OS] and disease-free survival [DFS]) were compared, as well as in patients with tumors located in the greater curvature and those with Borrmann type IV disease.

Results

The 5-year OS and DFS rates after PSM were not significantly different between Groups 1 and 2 (57.3% vs. 62.1%, p = 0.300; 52.8% vs. 59.7%, p = 0.100, respectively). Furthermore, the 5-year OS and DFS rates in patients with greater curvature involvement (54.4% vs. 61.9%, p = 0.500; 50.0% vs. 57.6%, p = 0.400, respectively) and Borrmann type IV disease (23.8% vs. 38.6%, p = 0.400; 16.7% vs. 33.9%, p = 0.200, respectively) after PSM were also not significantly different between the two groups.

Conclusions

Prophylactic splenic hilar LND without splenectomy does not improve long-term survival in PAGC. Therefore, this procedure might not be essential for patients with PAGC as well greater curvature involvement and Borrmann type IV disease.

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Funding

This work was funded by a grant from the National Cancer Center, Republic of Korea (NCC 2010150-1).

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Authors and Affiliations

  1. Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, South Korea

    Yoon Jung Oh MD, Deok Hee Kim RN, Bang Wool Eom MD, PhD, Hong Man Yoon MD, PhD, Young-Woo Kim MD, PhD & Keun Won Ryu MD, PhD

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  1. Yoon Jung Oh MD
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  2. Deok Hee Kim RN
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Correspondence to Keun Won Ryu MD, PhD.

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Yoon Jung Oh, Deok Hee Kim, Bang Wool Eom, Hong Man Yoon, Young-Woo Kim, and Keun Won Ryu have no conflicts of interest to declare.

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Oh, Y.J., Kim, D.H., Eom, B.W. et al. Is Splenic Hilar Lymph Node Dissection Without Splenectomy Essential for Proximal Advanced Gastric Cancer?. Ann Surg Oncol 28, 8952–8961 (2021). https://doi.org/10.1245/s10434-021-10354-x

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