Current best practices and rationalistic perspectives in causation-based prevention, early detection and multidisciplinary treatment of breast and gastric cancer

Gastric & Breast Cancer
DOI: 10.2122/gbc.2002.0006


Preservation vs Resection of the Spleen for Gastric Cancer

Matthias Lorenz, MD, Dimitrios H. Roukos, MD, Christof Hottenrott, MD and Albrecht Encke, MD

From the Departments of Surgery (DHR) and Pathology (NJA), Ioannina University School of Medicine, 45110 Ioannina, Greece,

Pathology and Quality Control for Appropriate Patient Stratification
Statistical Analysis


Background Resection of the spleen en-block with the stomach for gastric cancer is still widely performed for a curative resection (R0), but the presence of the spleen may influence outcome. Balancing risks and benefits of spleen preservation is challenging. We tested the hypothesis that in the critical early postsurgical period, the spleen interferes with the surgical stress-induced immunosuppression promoted by splenectomy, resulting in a suppression of recurrencedevelopment from micrometastasis.

Methods Patients were included if they underwent gastrectomy, with or without splenectomy, for a gastric adenocarcinoma. Standardized, strongly-defined criteria were used for stratification of patients who had an extended (D2) lymph node dissection into the R0 group [limited (D1) resection is insufficient for R-stratification). Prospectively defined primary endpoints were early (within two years) and overall recurrence and death from any cause, and secondary endpoints were postsurgical risks (morbidity, mortality) and metastases to the splenic hilum nodes.

Results Overall survival for total population studied (n=202; intent-to-treat) was better for preservation-versusresection of the spleen among R0 patients (p=0.0001), but not for those with non-curative resection (p=0.42). On R0 D2 group of patients, preservation (n=59) over resection (n=67) of the spleen, given similar postsurgical mortality (3.4% vs 0%), produced at a median follow-up of1 12 months a significant reduction in risks of early recurrence (HR, 0.33; 95% CI, 0.16 to 0.69; p=0.003), overall recurrence (p=0.002) and death from any cause (p=0.009) after adjustment analysis.

This treatment effect was consistent with subgroup analyses according to the prognostic factors (nodal/serosal status) needed because of significant imbalance of these variables at baseline. In multivariate analysis, preservation of the spleen was an independent predictor of outcome. An overestimation of the risk for residual disease in the splenic hilum nodes in the case of spleen preservation was obtained in 94% of splenectomized patients.

Conclusions Our findings indicate that preservation of the spleen is associated with a clearly reduced risk of early and overall recurrence translated into a better survival in patients receiving curative surgery for gastric cancer.

Key Words: gastric cancer, gastrectomy with spleen preservation / splenectomy, recurrence, survival

Online ISSN : 1109 - 7647
   Print ISSN : 1109 - 7655

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last update: 22 May 2003