Original CommunicationsA prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma*
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.Empty Cell TG (n = 97) TGS (n = 90) Empty Cell Complications % n % n P value Fever > 38°C 39 40 50 45 <.04 Pulmonary 24 24 39 35 <.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
References (36)
- et al.
Postoperative morbidity and mortality after D1 and d2 resections for gastric cancer: preliminary results of the MRC randomized controlled surgical trial
Lancet
(1996) The general rules for gastric cancer study in surgery and pathology
(1978)- et al.
A system for registration and classification of the stomach cancer for WHO International reference center
Jpn J Clin Oncol
(1973) - et al.
Gastric cancer
(1984) Japanese Research Society for the Study of Gastric Cancer: the general rules for gastric cancer study in surgery and pathology
Jpn J Surg
(1981)- et al.
Pancreas-preserving total gastrectomy for proximal gastric cancer
World J Surg
(1995) - et al.
Lack of benefit of combined pancreato-splenectomy in D2 resection for proximal third gastric carcinoma
World J Surg
(1997) - et al.
Lymph node dissection around the splenic artery: a comparative study of pancreatectomy and pancreas preserving operation
Nippon Geka Gakkai
(1992) - et al.
Splenectomy does not correlate with length of survival in patients undergoing curative total gastrectomy for gastric carcinoma
Cancer
(1991) - et al.
The negative effect of splenectomy on the prognosis of gastric cancer
Am J Surg
(1984)
Evaluation of splenectomy in total gastrectomy for gastric cancer
Nippon Geka Gakkai Zasshi
The role of spleen in immunosupression and the effects of splenectomy on prognosis in gastric cancer patients
Nippon Geka Gakkai Zasshi
Role of lymph node dissection and splenectomy in node-positive gastric carcinoma
Surgery
Impact of splenectomy on survival following gastrectomy for adenocarcinoma
Am Surg
Effect of splenectomy on morbidity and survival following curative gastrectomy for carcinoma
Arch Surg
Postoperative complications and mortality after surgery for gastric cancer
Ann Surg
Severe late post-splenectomy infection
Surgery
Preservation of the spleen improves survival after radical surgery for gastric cancer
Gut
Cited by (203)
Prevention and management of complications related to laparoscopic spleen-preserving hilar lymph node dissection for gastric cancer
2023, Chinese Journal of Gastrointestinal Surgery / Zhonghua Wei Chang Wai Ke Za ZhiClinical efficacy and safety of adjuvant immunotherapy (Tislelizumab) plus chemotherapy vs. adjuvant chemotherapy alone in lymph node-positive patients with gastric cancer after D2 radical resection: a prospective, 2-arm, phase II study
2023, European Review for Medical and Pharmacological Sciences
- *
Reprint requests: Attila Csendes, MD, Professor and Chairman, Department of Surgery, Hospital J.J. Aguirre, Santos Dumont 999, Santiago, Chile.