Differential effects of radical D2-lymphadenectomy and splenectomy in surgically treated gastric cancer patients.

Background/aims: Radical surgery with extended lymph node dissection (D2-LA) is the treatment of choice for gastric cancer patients in Japan. In Western countries results after D2-LA are controversially discussed, as increased D2-LA related complications are reported. The aim of this retrospective study was to analyze the influence of D2-LA and/or splenectomy on the clinical course, morbidity and long-term survival of gastric cancer patients.

Methodology: Included in this series are 243 consecutively treated gastric cancer patients with a median age of 63.8 years.

Results: Though 56% of the patients presented with stage III and IV tumors, a resection rate of 95.5% with R0-resections in 73.7% was achieved. D2-LA rate was 66.3% with simultaneous splenectomy in 48.7%. Global morbidity was 41.6%. Surgical morbidity, leakage and abscess rates after curative R0 resections were not influenced by D2-LA (22.5/6.5/6.5% vs. 21.9/9.1/3.0% +/- LA) but by splenectomy (31.6/13.2/11.8% vs. 14.7/2.1/1% +/- Sx). Simultaneous splenectomy was associated with 7 of 9 leakages, 7 of 9 abscesses, and 4 of 5 cases with postoperative pancreatitis. Long-term survival (Kaplan-Meier) was 40.6% for all, and 58.1% for R0 resected patients. It was not influenced by splenectomy (56/60.3% +/- Sx).

Conclusions: Radical D2-LA has no impact on the morbidity of gastric cancer patients, but splenectomy is always linked with elevated complications without improving survival rates. Therefore splenectomy as potential part of D2-LA can only be advocated in patients with direct infiltration of pancreas or spleen, in stage IV or whenever metastatic spread is supposed in the nodes along splenic artery or hilum.