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KMID : 0371320020630050397
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Journal of the Korean Surgical Society
2002 Volume.63 No. 5 p.397 ~ p.402
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Review of Splenectomy, Pancreas-preserving Splenectomy, Pancreatosplenectomy for Combined Radical Total Gastrectomy
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Min Gun-Sik
Cha Jin-Woo
Kim Myung-Wook
Cho Yong-Kwan
Han Sang-Uk
Kim Ji-Hun
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Abstract
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Purpose: Splenectomy, pancreas-preserving splenectomy, pancreato-splenectomy are common combined operations of a total gastrectomy for gastric cancer. We attempted to determine the efficacy of these procedures after comparing and analyzing
the
complication rate and the five-year survival rate from the gastric cancer patients.
Methods: 121 advanced gastric cancer patients, except T4 patients, underwent radical total gastrectomy accompanied with splenectomy. and analyzed the clinical findings eg. age, sex, location of tumor, histological differentiation, lymph
node
metastasis, number of dissected LN, complication and the 5-year survival rate.
Results: 44 out of 121 patients underwent a pancreato-splencetomy, 53 patients underwent a pancreas-preserving splenectomy, and 24 patients underwent a simple splenectomy. There were no statistical difference in the patient’s age, sex,
location
of tumor, histological differentiation, lymph node metastasis, the number of dissected LN and the 5 year-survival rate in stage Ⅱ, Ⅳ with each operation. However, a pancreas-preserving splenectomy showed a better 5-year survival rate (53.7%) than
a
simple splenectomy (25.0%) and pancreato-splenectomy (32.1%) in stage Ⅲ. The complication rate was 25% in a simple splenectomy, 17% in a pancreas-preserving splenectomy, 30% in a pancreato-splenectomy. Diabetes mellitus occurred in 3 patients
who
underwent a pancreato-splenectomy, in 1 patient with an iatrogenic splenic vein excision during a pancreas-preserving splenectomy.
Conclusion: A pancreas-preserving splenectomy is the best choice in stage IIIa total gastrectomy patients with the lowest complication rate.
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KEYWORD
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