Elsevier

Surgery

Volume 131, Issue 4, April 2002, Pages 401-407
Surgery

Original Communications
A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma*

https://doi.org/10.1067/msy.2002.121891Get rights and content

Abstract

Background. Classic surgical treatment of upper third gastric carcinoma is based on an extended total gastrectomy, including splenectomy. The purpose of this study was to perform a prospective randomized clinical trial comparing the early and late results of total gastrectomy (TG) versus total gastrectomy plus splenectomy (TGS). Methods. One hundred eighty-seven patients with gastric carcinoma were included. In all patients a D2 total gastrectomy was performed. During surgery they were randomized to 1 of 2 operative options. They were monitored to their death or to 5 years later if they were alive. Results. Operative mortality was similar after both operations (3% after TG and 4% after TGS). Septic complications after surgery were higher after TGS compared with TG (P <.04). Five-year survival rates were not statistically different between groups or in subset analysis according to stage of disease. Conclusions. On the basis of the results of the present prospective randomized trial, splenectomy is not necessary in early stages of disease. A low operative mortality rate (less than 3%) must be achieved to obtain good long-term results. (Surgery 2002;131:401-7.)

Section snippets

Patients

The present prospective, randomized study included 187 patients with gastric carcinoma confirmed by histologic analysis who underwent total gastrectomy between January 1985 and December 1992. The end of follow-up was December 1997. Patients with early gastric cancer were also included for randomization for splenectomy. Patients with gastric lymphoma, with gastric carcinoma with macroscopic intraoperative findings of tumor infiltration of the pancreas or spleen (15 cases), and patients with

Patient characteristics

Clinical and pathologic characteristics of all patients enrolled were similar according to the type of operation performed. There was a predominance of men over women (2:1). Mean age of patients was 62.7 years. About 16% of the patients had early gastric cancer.

Postoperative morbidity

The main postoperative septic complications are shown in Table I.

. Septic complications according to type of surgery (% patients)

Empty CellTG (n = 97)TGS (n = 90)Empty Cell
Complications%n%nP value
Fever > 38°C39405045<.04
Pulmonary24243935<.008
Subphrenic abscess

Discussion

This prospective, randomized single trial has shown for the first time that TGS has a similar operative mortality but significantly higher septic complications than TG in patients with gastric carcinoma of the upper and middle portions of the stomach. Second, preservation of the spleen after TG has a similar survival rate in the early stages (IA, IB, and II) and late stages (IIIA and IIIB) compared with survival rate after TGS.

The present trial only included patients who underwent D2

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    *

    Reprint requests: Attila Csendes, MD, Professor and Chairman, Department of Surgery, Hospital J.J. Aguirre, Santos Dumont 999, Santiago, Chile.

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