Clinical impact of splenic hilar dissection with splenectomy for gastric stump cancer.

BACKGROUND: Splenectomy for advanced gastric stump cancer (GSC) is performed in Japan, based on the concept that lymphatic flow toward the splenic hilum is dominant following initial gastrectomy. However, little has been reported on the therapeutic impact of complete splenic hilar dissection with splenectomy.

MATERIAL AND METHODS: A total of 184 patients who underwent R0 total gastrectomy with or without splenectomy for GSC between 1998 and 2015 were included in this retrospective analysis. Patients were divided into subgroups: patients with tumors involving the greater curvature (Gre group) and tumors without greater curvature involvement (non-Gre group), and each group was further divided into those with and without splenectomy. The incidence of lymph node (LN) metastasis, index of the estimated benefit from LN dissection in each station, and survival curves were compared.

RESULTS: The incidence of No.10 LN metastasis was higher in the Gre group than in the non-Gre group (16.7% vs. 2.0%, P = 0.036). The index of No.10 LN dissection was higher in the Gre group than in the non-Gre group (6.3 vs. 0). However, there was no tendency that splenectomy was superior to spleen preservation for survival outcomes in either group, although selection bias certainly existed.

CONCLUSIONS: In advanced GSC, similar to primary advanced proximal gastric cancer, splenectomy can be omitted unless the tumor infiltrates the greater curvature. Complete splenic hilar dissection may be expected to be beneficial for some patients with tumors infiltrating the greater curvature.