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2013 | 85 | 8 | 433-437
Tytuł artykułu

Morbidity, Mortality and Survival after Stomach Resection with or without Splenectomy – The Single Centre Observations

Treść / Zawartość
Warianty tytułu
Języki publikacji
EN
Abstrakty
EN
Over the last decade, gastric cancer treatment has changed from extensive multiorgan resections towards less invasive approaches with limited resections and a more selective lymphadenectomy. Despite all available trials, the conclusions on the extent of necessary resections still remain debatable. The aim of the study was to assess the short term outcomes (morbidity and mortality) of a total gastrectomy depending on the simultaneous splenectomy status. Material and methods. We performed a retrospective analysis of the records of all patients treated with a curative intent using a total gastrectomy for gastric cancer between 1997 and 2003. 49 patients fulfilled the inclusion criteria. Patients were divided into two groups: S(+) gastrectomy with splenectomy group (29 patients) and S(-) total gastrectomy with spleen preservation (20 patients). Results. Survival analysis at one year showed that there was no difference in survival between the two groups (p=0.84). There were six recurrences, one in the group S(+) and five in group S(-) (p>0.05). Dissemination was observed in three patients in group S(-) (p>0.05). Other complications including infectious complications, exenteration, subileus, cardiovascular insufficiency, multiorgan failure were more frequent in the S(+) group (31% v 15%) although the difference was not significant (p=0.17). Conclusions. Splenectomy during gastrectomy for cancer has no statistically significant impact on short-term morbidity and mortality. Even though it does not show benefit in terms of 5-year overall survival rates it might be performed when needed in more advanced cases in properly selected patients (e.g. upper gastric T3/4 gastric cancer)
Słowa kluczowe
Wydawca

Rocznik
Tom
85
Numer
8
Strony
433-437
Opis fizyczny
Daty
wydano
2013-08-01
online
2013-09-05
Twórcy
  • Department of General, Oncological and Vascular Surgery, Janusz Korczak Memorial Voivodeship General Hospital in Słupsk
  • Department of Oncological Surgery Medical University in Gdańsk
  • Department of Oncological Surgery Medical University in Gdańsk
  • Radiotherapy Department MSC Memorial Cancer Centre and Institute of Oncology in Gliwice
  • Radiology Department, Janusz Korczak Memorial Voivodeship General Hospital in Słupsk
  • Department of General Surgery, Gastrointestinal Oncological Surgery and Plastic Surgery Karol Marcinkowski, University of Medical Sciences in Poznań, tbanasiewicz@op.pl
Bibliografia
  • 1. Krajowa Baza Danych Nowotworów dostępna na stronie: http: //epid.coi.waw.pl/krn/, dostęp 29.06.2012
  • 2. Cuschieri A, Weeden S, Fielding J et al.: Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Br J Cancer 1999; 79(9-10): 1522-30.[Crossref]
  • 3. Bonenkamp JJ, Hermans J, Sasako M et al.: Dutch Gastric Cancer Group.Extended lymph-node dissection for gastric cancer. N Engl J Med 1999; 340: 908-14.
  • 4. Mönig SP, Collet PH, Baldus SE et al.: Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol 2001; 76: 89-92.
  • 5. Schmid A, Thybusch A, Kremer B, Henne-BrunsD: Differential effects of radical D2-lymphadenectomy and splenectomy in surgically treated gastric cancer patients. Hepatogastroenterology 2000; 47: 579-85.
  • 6. Yamamoto M, Baba H, Kakeji Y et al.: Postoperative morbidity/mortality and survival rates after total gastrectomy, with splenectomy/pancreaticosplenectomy for patients with advanced gastric cancer. Hepatogastroenterology 2004; 51: 298-302.
  • 7. Huang CM , Wang JB, Lu HS et al.: Prognostic impact of splenectomy on advanced proximal gastric cancer with No. 10 lymph node metastasis. Chin Med J (Engl). 2009; 122: 2757-62.
  • 8. Brady MS , Rogatko A, Dent LL , Shiu MH : Effect of splenectomy on morbidity and survival following curative gastrectomy for carcinoma. Arch Surg 1991; 126: 359-64.
  • 9. Weitz J, Jaques DP, Brennan M, Karpeh M: Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer. Ann Surg Oncol 2004; 11: 682-89.[Crossref][PubMed]
  • 10. Knight G, Earle CC , Cosby R et al.: The Gastrointestinal Cancer Disease Site Group. Neoadjuvant or adjuvant therapy for resectable gastric cancer: a systematic review and practice guideline for North America. Gastric Cancer. 2012 Mar 31. (Epub ahead of print).[WoS]
  • 11. GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group, Paoletti X, Oba K, Burzykowski T, Michiels S, Ohashi Y, Pignon JP, et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a metaanalysis. JAMA 2010; 303: 1729-37.
  • 12. Adachi Y, Kamakura T, Mori M et al.: Role of lymph node dissection and splenectomy in nodepositive gastric carcinoma. Surgery 1994; 116: 837-41.
  • 13. Di Sabatino A, Carsetti R, Corazza GR: Postsplenectomy and hyposplenic states. Lancet 2011; 378: 86-97.[WoS]
  • 14. Yu W, Choi GS, Chung HY : Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 2006; 93: 559-63.
  • 15. Sasada S, Ninomiya M, Nishizaki M et al.: Frequency of lymph node metastasis to the splenic hilus and effect of splenectomy in proximal gastric cancer. Anticancer Res 2009; 29: 3347-51.
  • 16. Li C, Kim S, Lai JF et al.: Lymph node dissection around the splenic artery and hilum in advanced middle third gastric carcinoma. Eur J SurgOncol 2009; 35: 709-14.
  • 17. Fang WL , Huang KH , Wu CW et al.: Combined splenectomy does not improve survival in radical total gastrectomy for advanced gastric cardia cancer. Hepatogastroenterology 2012; 59: 1150-54.
  • 18. Wanebo HJ, Kennedy BJ, Winchester DP et al.: Role of splenectomy in gastric cancer surgery: adverse effect of elective splenectomy on long-term survival. J Am Coll Surg 1997; 185: 177-84.
  • 19. Cheong O, Kim BS, Yook JH et al.: Modified radical lymphadenectomy without splenectomy in patients with proximal gastric cancer: comparison with standard D2 lymphadenectomy for distal gastric cancer. J Surg Oncol 2008; 98: 500-04.[WoS][Crossref][PubMed]
  • 20. Oh SJ, Hyung WJ, Li C et al.: The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer. J Surg Oncol 2009; 99: 275-80.
  • 21. Zhang CH , Zhan WH , He YL et al.: Spleen preservation in radical surgery for gastric cardia cancer. Ann SurgOncol 2007; 14: 1312-19.
  • 22. Yang K, Chen XZ, Hu JK et al.: Effectiveness and safety of splenectomy for gastric carcinoma: a meta-analysis. World J Gastroenterol 2009; 15: 5352-59.[PubMed][Crossref]
Typ dokumentu
Bibliografia
Identyfikatory
Identyfikator YADDA
bwmeta1.element.-psjd-doi-10_2478_pjs_2013_85_8_433
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