A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 15; no. Suppl 1; pp. 89 - 99
• Main Authors: Brar, Savtaj S., Seevaratnam, Rajini, Cardoso, Roberta, Law, Calvin, Helyer, Lucy, Coburn, Natalie
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.09.2012; Springer Nature B.V
• Subjects: Abdominal Surgery; Cancer Research; Gastric cancer; Gastroenterology; Humans; Lymph Node Excision - methods; Medicine; Medicine & Public Health; Oncology; Pancreas - pathology; Pancreas - surgery; Pancreatectomy - methods; Pancreatectomy - mortality; Prognosis; Review Article; Spleen - pathology; Spleen - surgery; Splenectomy - methods; Splenectomy - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgical Oncology; Survival Rate; Spleen; Lymphadenectomy; Pancreas; Gastric cancer; Surgery
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-011-0087-4

Background The overall prognosis and survival of patients with advanced gastric cancer are generally poor. Extended lymphadenectomy is recommended for patients with advanced gastric cancer; however, splenectomy and distal pancreatectomy performed with an extended lymph node dissection may be associated with increased morbidity and mortality. Method Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 31 December 2009. Studies on gastric carcinoma investigating extended lymphadenectomy with splenectomy and/or pancreaticosplenectomy that reported data on surgical outcomes or survival were selected. Results Forty studies were included in this review. Decreased complication rates were demonstrated with spleen preservation in two prospective studies and three retrospective studies, and with pancreas preservation in five retrospective studies. No randomized controlled trial showed survival benefit or detriment for preservation of spleen or pancreas in extended lymphadenectomy. Improved survival was demonstrated with spleen preservation in two prospective and eight retrospective studies, and with pancreas preservation in one prospective and four retrospective studies. Conclusions Preservation of the spleen and pancreas during extended lymphadenectomy for gastric cancer decreases complications with no clear evidence of improvement or detriment to overall survival.