To know the effect of splenectomy with total gastrectomy in gastric cancer patients on their survial, 200 cases of total gastrectomy with or without splenectomy, performed from 1988 to 1994 at the Department of Surgery, Hanyang University
Hospital
were
analysed.
@ES The results were as follows;
@EN 1) There were 124 males and 76 females and the locations of the tumor were cardia in 34 cases, body in 109 cases, antrum in 20 cases and whole stomach in 37 cases. There were 63 cases without splenectomy and 137 cases with splenectomy. There
were no
statistically significant differences about age and gender of patients, site and gross type of tumor and clinical stage analyzed by chi-wquare test.
2) There were 13.0% of early gastric cancer, 13.5% of StageⅡ, 5.7.5% of StageⅢand 16.0% of stageⅣ.
3) The 5-year survival rate was 72.8% in StageⅡ, 56.3% Stage inⅢa, 27.8% in StageⅢb. The mean survival of StageⅣwas 11.0 months.
4) The 5-year survival rate of non-splenectomy group was 83.3% in StageⅡ, 52.8% in StageⅢa, 37.5% in StageⅢb. the mean survival of StageⅣwas 8.0months.
5) the 5-year survival rate of splenectomy group was 68.7% in StageⅡ, 56.4% in stageⅢa, 22.6% in StageⅢb. The mean survival of StagⅣwas 11.8 months. There were no statistically significant differences in 5-year survival rate between
non-splenctomy
and splenectomy groups, when compared accoring to same stage with each another.
6) The postoperative complications were 9 cases of pleural effusion, 7 cases of pneumonia. 3 cases of atelectasis, 3 cases of anastomotic leakage, 2 cases of bleeding, 1 case of wound infection, 1 case of intraabdominal abscess and 1 case of
unknown
fever. There were 24 cases of complication among the 137 splenectomy patients and 3 cases of complications among the 63 non-splenectomy patients. There was a more frequent complication rate in splenctomy group than in non-splenectomy group with
statistically significant difference(p>0.001).
Since splenctomy as a more radical measure for dissection of the splenic hlium increases postoperative complications and doesn't seem to increase the 5-year survival rate, preventive splenectomy in total gastrectomy for gastric cancer patients
should be
reconsidered and a prospective randomized study be undertaken.
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