Postoperative Morbidity/Mortality and Survival Rates after Total Gastrectomy, with Splenectomy/Pancreaticosplenectomy for Patients with Advanced Gastric Cancer

Manabu Yamamoto, Hideo Baba, Yoshihiro Kakeji, Kazuya Endo, Yasuharu Ikeda, Yasushi Toh, Shunji Kohnoe, Takeshi Okamura, Yoshihiko Maehara

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Abstract

Background/Aims: Indications for splenectomy in patients with proximal and middle gastric cancer remain controversial. We investigated characteristic findings in patients with lymph node metastasis to the splenic hilus and the indication of splenectomy with total gastectomy for T2 and T3 advanced gastric cancer. Methodology: Two hundred and forty-one Japanese patients underwent curative operations for T2 and T3 advanced gastric cancer. Results: The mortality rates were similar, but the morbidity rate for patients who underwent pancreaticosplenectomy was higher than for patients who underwent either total gastrectomy alone or with splenectomy (p<0.007). The rates in cases of lymph node metastasis at the depth of tumor invasion within the subserosa and serosa (T3) were 1.7% and 17.5%, respectively (p<0.003). Lymph node metastasis to the splenic hilus was also evident in patients with T3 or T2 advanced gastric cancer with multiple lymph nodes metastasis (more than 7 nodes). The 10-year survival rates for patients who underwent total gastrectomy alone, with splenectomy, and with pancreaticosplenectomy in T3 advanced gastric cancers were 25%, 42% and 32%, respectively (p=0.184). Conclusions: Based on these data, the addition of distal pancreaticosplenectomy to total gastrectomy in patients with T2 and T3 advanced gastric cancer increased the risk of complications. Nevertheless, we recommend that total gastrectomy with splenectomy should be done for patients with T3 advanced gastric cancers [and T2 advanced gastric cancer with multiple lymph nodes metastasis (more than 7 nodes)], recognizing the lymph node metastasis to the splenic hilus.

Original languageEnglish
Pages (from-to)298-302
Number of pages5
JournalHepato-gastroenterology
Volume51
Issue number55
Publication statusPublished - Jan 1 2004

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Splenectomy
Gastrectomy
Stomach Neoplasms
Survival Rate
Morbidity
Mortality
Lymph Nodes
Neoplasm Metastasis
Serous Membrane

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Postoperative Morbidity/Mortality and Survival Rates after Total Gastrectomy, with Splenectomy/Pancreaticosplenectomy for Patients with Advanced Gastric Cancer. / Yamamoto, Manabu; Baba, Hideo; Kakeji, Yoshihiro; Endo, Kazuya; Ikeda, Yasuharu; Toh, Yasushi; Kohnoe, Shunji; Okamura, Takeshi; Maehara, Yoshihiko.

In: Hepato-gastroenterology, Vol. 51, No. 55, 01.01.2004, p. 298-302.

Research output: Contribution to journalArticle

Yamamoto, M, Baba, H, Kakeji, Y, Endo, K, Ikeda, Y, Toh, Y, Kohnoe, S, Okamura, T & Maehara, Y 2004, 'Postoperative Morbidity/Mortality and Survival Rates after Total Gastrectomy, with Splenectomy/Pancreaticosplenectomy for Patients with Advanced Gastric Cancer', Hepato-gastroenterology, vol. 51, no. 55, pp. 298-302.
Yamamoto, Manabu ; Baba, Hideo ; Kakeji, Yoshihiro ; Endo, Kazuya ; Ikeda, Yasuharu ; Toh, Yasushi ; Kohnoe, Shunji ; Okamura, Takeshi ; Maehara, Yoshihiko. / Postoperative Morbidity/Mortality and Survival Rates after Total Gastrectomy, with Splenectomy/Pancreaticosplenectomy for Patients with Advanced Gastric Cancer. In: Hepato-gastroenterology. 2004 ; Vol. 51, No. 55. pp. 298-302.
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AU - Baba, Hideo

AU - Kakeji, Yoshihiro

AU - Endo, Kazuya

AU - Ikeda, Yasuharu

AU - Toh, Yasushi

AU - Kohnoe, Shunji

AU - Okamura, Takeshi

AU - Maehara, Yoshihiko

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N2 - Background/Aims: Indications for splenectomy in patients with proximal and middle gastric cancer remain controversial. We investigated characteristic findings in patients with lymph node metastasis to the splenic hilus and the indication of splenectomy with total gastectomy for T2 and T3 advanced gastric cancer. Methodology: Two hundred and forty-one Japanese patients underwent curative operations for T2 and T3 advanced gastric cancer. Results: The mortality rates were similar, but the morbidity rate for patients who underwent pancreaticosplenectomy was higher than for patients who underwent either total gastrectomy alone or with splenectomy (p<0.007). The rates in cases of lymph node metastasis at the depth of tumor invasion within the subserosa and serosa (T3) were 1.7% and 17.5%, respectively (p<0.003). Lymph node metastasis to the splenic hilus was also evident in patients with T3 or T2 advanced gastric cancer with multiple lymph nodes metastasis (more than 7 nodes). The 10-year survival rates for patients who underwent total gastrectomy alone, with splenectomy, and with pancreaticosplenectomy in T3 advanced gastric cancers were 25%, 42% and 32%, respectively (p=0.184). Conclusions: Based on these data, the addition of distal pancreaticosplenectomy to total gastrectomy in patients with T2 and T3 advanced gastric cancer increased the risk of complications. Nevertheless, we recommend that total gastrectomy with splenectomy should be done for patients with T3 advanced gastric cancers [and T2 advanced gastric cancer with multiple lymph nodes metastasis (more than 7 nodes)], recognizing the lymph node metastasis to the splenic hilus.

AB - Background/Aims: Indications for splenectomy in patients with proximal and middle gastric cancer remain controversial. We investigated characteristic findings in patients with lymph node metastasis to the splenic hilus and the indication of splenectomy with total gastectomy for T2 and T3 advanced gastric cancer. Methodology: Two hundred and forty-one Japanese patients underwent curative operations for T2 and T3 advanced gastric cancer. Results: The mortality rates were similar, but the morbidity rate for patients who underwent pancreaticosplenectomy was higher than for patients who underwent either total gastrectomy alone or with splenectomy (p<0.007). The rates in cases of lymph node metastasis at the depth of tumor invasion within the subserosa and serosa (T3) were 1.7% and 17.5%, respectively (p<0.003). Lymph node metastasis to the splenic hilus was also evident in patients with T3 or T2 advanced gastric cancer with multiple lymph nodes metastasis (more than 7 nodes). The 10-year survival rates for patients who underwent total gastrectomy alone, with splenectomy, and with pancreaticosplenectomy in T3 advanced gastric cancers were 25%, 42% and 32%, respectively (p=0.184). Conclusions: Based on these data, the addition of distal pancreaticosplenectomy to total gastrectomy in patients with T2 and T3 advanced gastric cancer increased the risk of complications. Nevertheless, we recommend that total gastrectomy with splenectomy should be done for patients with T3 advanced gastric cancers [and T2 advanced gastric cancer with multiple lymph nodes metastasis (more than 7 nodes)], recognizing the lymph node metastasis to the splenic hilus.

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