Background/Aims: The role of splenectomy in the surgical management of gast
ric carcinoma is controversial and there is no consensus of opinion regardi
ng the therapeutic value of splenectomy. The aim of this study was to searc
h for possible metastasis to lymph nodes in the splenic hilum or along the
splenic artery to avoid unnecessary splenectomy and to determine its indica
tion.
Methodology: The clinical recordes of 204 paients who underwent total gastr
ectomy combined with splenectomy for gastric carcinomas involving the proxi
mal part of the stomach were analyzed.
Results: The incidence of nodal involvement to the splenic hilum and/or alo
ng the splenic artery was 49 (24.0%) of 204 gastric carcinomas involving th
e proximal part of the stomach that underwent combined gastrectomy and sple
nectomy. The characteristics of gastric carcinoma with metastasis to these
nodes included a larger tumor, deeper penetration (T3, 4 tumors), a number
of lymph node metastasis, and infiltrative type. In T2 cases, all the tumor
s with cancerous involvement to these nodes showed intraoperative gross ser
osal change). When the tumor size was less than 40mm, nodal metastatic rate
to the splenic hilum and/or along the splenic artery was very low.
Conclusions: In conclusion, splenectomy should be conducted in T2 cases wit
h gross serosal change and T3, 4 cases. With regard to tumor size, in the c
ases with a tumor whose size was less than 40mm, it is possible to preserve
the spleen in most cases. In the near future, splenectomy should be clarif
ied precisely by randomized trials in advanced gastric carcinoma.