Indication of splenectomy for gastric carcinoma involving the proximal part of the stomach

Citation
T. Sakaguchi et al., Indication of splenectomy for gastric carcinoma involving the proximal part of the stomach, HEP-GASTRO, 48(38), 2001, pp. 603-605
Citations number
20
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Gastroenerology and Hepatology","da verificare
Journal title
HEPATO-GASTROENTEROLOGY
ISSN journal
0172-6390 → ACNP
Volume
48
Issue
38
Year of publication
2001
Pages
603 - 605
Database
ISI
SICI code
0172-6390(200103/04)48:38<603:IOSFGC>2.0.ZU;2-B
Abstract
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.