1. Systemic Review and Meta-analysis of Impact of Splenectomy for Advanced Gastric Cancer
- Author
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Kohei Kasahara, Chikara Kunisaki, Hirotoshi Akiyama, Takashi Kosaka, Itaru Endo, Sho Sato, Tsutomu Sato, Nobuhiro Tsuchiya, Toshihiro Misumi, Jun Watanabe, and Kazuhisa Takeda
- Subjects
Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Splenectomy ,Review Article ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,Stomach Neoplasms ,medicine ,Humans ,Retrospective Studies ,Pharmacology ,business.industry ,Stomach ,Postoperative complication ,Cancer ,Retrospective cohort study ,medicine.disease ,Curvatures of the stomach ,Surgery ,medicine.anatomical_structure ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Lymph Node Excision ,business ,Spleen - Abstract
Background/aim Prophylactic splenectomy has shown no inferiority for tumors not invading the greater curvature side. Despite this, the clinical impact of prophylactic splenectomy for proximal advanced gastric cancer is not clear. This review aimed to clarify the impact of splenectomy for advanced gastric cancer in the upper third of the stomach. Materials and methods A systematic review and meta-analysis were conducted based on PubMed and EMBASE databases. The following search terms were used: "gastric cancer" OR "splenectomy" OR upper third of the stomach" OR preservation of the spleen. Results Out of 765 articles, 18 studies (combined n=6,341) were included in the analysis. Four randomized controlled trials (RCT) and eight retrospective studies suggested the benefits of spleen-preserving gastrectomy. Six retrospective studies showed no significant benefit of spleen-preserving gastrectomy. Prophylactic splenectomy showed a close association with a higher incidence of postoperative morbidity (pancreatic fistula and anastomotic leakage) with no concomitant improvement in overall survival. Prophylactic splenectomy should not be routinely performed and RCTs are necessary to confirm the impact of splenectomy for cN(+) at the splenic hilum tumors and tumors invading the greater curvature.
- Published
- 2020