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. 1995 May;36(5):684–690. doi: 10.1136/gut.36.5.684

Preservation of the spleen improves survival after radical surgery for gastric cancer.

J P Griffith 1, H M Sue-Ling 1, I Martin 1, M F Dixon 1, M J McMahon 1, A T Axon 1, D Johnston 1
PMCID: PMC1382670  PMID: 7797117

Abstract

One hundred and ninety five consecutive, potentially curative resections for adenocarcinoma of the stomach were performed in one surgical department between 1970 and 1989: 76 patients underwent gastrectomy with splenectomy and 119 gastrectomy without splenectomy. Operative mortality was 12% after gastrectomy with splenectomy, but only 2.5% after gastrectomy without splenectomy (p < 0.05). Postoperative complications were also significantly more common when splenectomy was combined with gastrectomy (41% v 14%, p < 0.01). Cumulative five year survival was 45% after gastrectomy with splenectomy, compared with 71% after gastrectomy alone (p < 0.01). When the results of the two groups of patients were compared, stage for pathological stage, no evidence was found that splenectomy improved survival. Application of Cox's proportional hazards model, which makes allowance for other variables such as the T and N stages, showed that splenectomy had an adverse influence on patients' survival. Splenectomy does not benefit the patient and its routine use in the course of radical resections for carcinoma of the stomach should be abandoned.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akoh J. A., Sedgwick D. M., Macintyre I. M. Improving results in the treatment of gastric cancer: an 11-year audit. Br J Surg. 1991 Mar;78(3):349–351. doi: 10.1002/bjs.1800780325. [DOI] [PubMed] [Google Scholar]
  2. Aldridge M. C., Williamson R. C. Distal pancreatectomy with and without splenectomy. Br J Surg. 1991 Aug;78(8):976–979. doi: 10.1002/bjs.1800780827. [DOI] [PubMed] [Google Scholar]
  3. Allum W. H., Powell D. J., McConkey C. C., Fielding J. W. Gastric cancer: a 25-year review. Br J Surg. 1989 Jun;76(6):535–540. doi: 10.1002/bjs.1800760604. [DOI] [PubMed] [Google Scholar]
  4. Billiar T. R., West M. A., Hyland B. J., Simmons R. L. Splenectomy alters Kupffer cell response to endotoxin. Arch Surg. 1988 Mar;123(3):327–332. doi: 10.1001/archsurg.1988.01400270061009. [DOI] [PubMed] [Google Scholar]
  5. Blot W. J., Devesa S. S., Kneller R. W., Fraumeni J. F., Jr Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA. 1991 Mar 13;265(10):1287–1289. [PubMed] [Google Scholar]
  6. Brady M. S., Rogatko A., Dent L. L., Shiu M. H. Effect of splenectomy on morbidity and survival following curative gastrectomy for carcinoma. Arch Surg. 1991 Mar;126(3):359–364. doi: 10.1001/archsurg.1991.01410270105017. [DOI] [PubMed] [Google Scholar]
  7. Carlstedt A., Tholin B. Infectious complications after splenectomy. Acta Chir Scand. 1984;150(8):607–610. [PubMed] [Google Scholar]
  8. Cullingford G. L., Watkins D. N., Watts A. D., Mallon D. F. Severe late postsplenectomy infection. Br J Surg. 1991 Jun;78(6):716–721. doi: 10.1002/bjs.1800780626. [DOI] [PubMed] [Google Scholar]
  9. Cuschieri A. Gastrectomy for gastric cancer: definitions and objectives. Br J Surg. 1986 Jul;73(7):513–514. doi: 10.1002/bjs.1800730702. [DOI] [PubMed] [Google Scholar]
  10. Danforth D. N., Jr, Thorbjarnarson B. Incidental splenectomy: a review of the literature and the New York Hospital experience. Ann Surg. 1976 Feb;183(2):124–129. doi: 10.1097/00000658-197602000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Davis C. J., Ilstrup D. M., Pemberton J. H. Influence of splenectomy on survival rate of patients with colorectal cancer. Am J Surg. 1988 Jan;155(1):173–179. doi: 10.1016/s0002-9610(88)80276-9. [DOI] [PubMed] [Google Scholar]
  12. Di Padova F., Dürig M., Wadström J., Harder F. Role of spleen in immune response to polyvalent pneumococcal vaccine. Br Med J (Clin Res Ed) 1983 Dec 17;287(6408):1829–1832. doi: 10.1136/bmj.287.6408.1829. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Downey E. C., Shackford S. R., Fridlund P. H., Ninnemann J. L. Long-term depressed immune function in patients splenectomized for trauma. J Trauma. 1987 Jun;27(6):661–663. doi: 10.1097/00005373-198706000-00010. [DOI] [PubMed] [Google Scholar]
  14. Holdsworth R. J., Irving A. D., Cuschieri A. Postsplenectomy sepsis and its mortality rate: actual versus perceived risks. Br J Surg. 1991 Sep;78(9):1031–1038. doi: 10.1002/bjs.1800780904. [DOI] [PubMed] [Google Scholar]
  15. Kodama Y., Sugimachi K., Soejima K., Matsusaka T., Inokuchi K. Evaluation of extensive lymph node dissection for carcinoma of the stomach. World J Surg. 1981 Mar;5(2):241–248. doi: 10.1007/BF01658301. [DOI] [PubMed] [Google Scholar]
  16. Koga S., Kaibara N., Kimura O., Nishidoi H., Kishimoto H. Prognostic significance of combined splenectomy or pancreaticosplenectomy in total and proximal gastrectomy for gastric cancer. Am J Surg. 1981 Nov;142(5):546–550. doi: 10.1016/0002-9610(81)90422-0. [DOI] [PubMed] [Google Scholar]
  17. MacFarlane J. K., Ryall R. D., Heald R. J. Mesorectal excision for rectal cancer. Lancet. 1993 Feb 20;341(8843):457–460. doi: 10.1016/0140-6736(93)90207-w. [DOI] [PubMed] [Google Scholar]
  18. Maehara Y., Moriguchi S., Yoshida M., Takahashi I., Korenaga D., Sugimachi K. Splenectomy does not correlate with length of survival in patients undergoing curative total gastrectomy for gastric carcinoma. Univariate and multivariate analyses. Cancer. 1991 Jun 15;67(12):3006–3009. doi: 10.1002/1097-0142(19910615)67:12<3006::aid-cncr2820671213>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  19. McArdle C. S., Hole D. Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. BMJ. 1991 Jun 22;302(6791):1501–1505. doi: 10.1136/bmj.302.6791.1501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Meyer H. J., Jähne J., Wilke H., Pichlmayr R. Surgical treatment of gastric cancer: retrospective survey of 1,704 operated cases with special reference to total gastrectomy as the operation of choice. Semin Surg Oncol. 1991 Nov-Dec;7(6):356–364. doi: 10.1002/ssu.2980070607. [DOI] [PubMed] [Google Scholar]
  21. Morris D. H., Bullock F. D. THE IMPORTANCE OF THE SPLEEN IN RESISTANCE TO INFECTION. Ann Surg. 1919 Nov;70(5):513–521. doi: 10.1097/00000658-191911000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Pimpl W., Dapunt O., Kaindl H., Thalhamer J. Incidence of septic and thromboembolic-related deaths after splenectomy in adults. Br J Surg. 1989 May;76(5):517–521. doi: 10.1002/bjs.1800760528. [DOI] [PubMed] [Google Scholar]
  23. Powell J., McConkey C. C. Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. Br J Cancer. 1990 Sep;62(3):440–443. doi: 10.1038/bjc.1990.314. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Robertson D. A., Simpson F. G., Losowsky M. S. Blood viscosity after splenectomy. Br Med J (Clin Res Ed) 1981 Aug 29;283(6291):573–575. doi: 10.1136/bmj.283.6291.573. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Robinette C. D., Fraumeni J. F., Jr Splenectomy and subsequent mortality in veterans of the 1939-45 war. Lancet. 1977 Jul 16;2(8029):127–129. doi: 10.1016/s0140-6736(77)90132-5. [DOI] [PubMed] [Google Scholar]
  26. Schwartz P. E., Sterioff S., Mucha P., Melton L. J., 3rd, Offord K. P. Postsplenectomy sepsis and mortality in adults. JAMA. 1982 Nov 12;248(18):2279–2283. [PubMed] [Google Scholar]
  27. Siewert J. R., Böttcher K., Roder J. D., Busch R., Hermanek P., Meyer H. J. Prognostic relevance of systematic lymph node dissection in gastric carcinoma. German Gastric Carcinoma Study Group. Br J Surg. 1993 Aug;80(8):1015–1018. doi: 10.1002/bjs.1800800829. [DOI] [PubMed] [Google Scholar]
  28. Sue-Ling H. M., Johnston D., Martin I. G., Dixon M. F., Lansdown M. R., McMahon M. J., Axon A. T. Gastric cancer: a curable disease in Britain. BMJ. 1993 Sep 4;307(6904):591–596. doi: 10.1136/bmj.307.6904.591. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Suehiro S., Nagasue N., Ogawa Y., Sasaki Y., Hirose S., Yukaya H. The negative effect of splenectomy on the prognosis of gastric cancer. Am J Surg. 1984 Nov;148(5):645–648. doi: 10.1016/0002-9610(84)90343-x. [DOI] [PubMed] [Google Scholar]
  30. Sugimachi K., Kodama Y., Kumashiro R., Kanematsu T., Noda S., Inokuchi K. Critical evaluation of prophylactic splenectomy in total gastrectomy for the stomach cancer. Gan. 1980 Oct;71(5):704–709. [PubMed] [Google Scholar]
  31. Warshaw A. L. Conservation of the spleen with distal pancreatectomy. Arch Surg. 1988 May;123(5):550–553. doi: 10.1001/archsurg.1988.01400290032004. [DOI] [PubMed] [Google Scholar]
  32. Ziemski J. M., Rudowski W. J., Jaskowiak W., Rusiniak L., Scharf R. Evaluation of early postsplenectomy complications. Surg Gynecol Obstet. 1987 Dec;165(6):507–514. [PubMed] [Google Scholar]

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