Junttila Anna, Helminen Olli, Helmiö Mika, Huhta Heikki, Jalkanen Aapo, Kallio Raija, Koivukangas Vesa, Kokkola Arto, Laine Simo, Lietzen Elina, Louhimo Johanna, Meriläinen Sanna, Pohjanen Vesa-Matti, Rantanen Tuomo, Ristimäki Ari, Räsänen Jari V, Saarnio Juha, Sihvo Eero, Toikkanen Vesa, Tyrväinen Tuula, Valtola Antti, Kauppila Joonas H
Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.
Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
J Gastrointest Surg. 2024 Dec;28(12):2090-2096. doi: 10.1016/j.gassur.2024.10.009. Epub 2024 Oct 10.
No national studies comparing long-term survival after total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation exist. This study aimed to examine the 5-year overall survival (OS) of patients with gastric adenocarcinoma who underwent total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation in a population-based nationwide setting.
This study included all patients undergoing total or partial gastrectomy with splenectomy or spleen preservation for gastric adenocarcinoma in Finland from 2005 to 2016, with follow-up until December 31, 2019. A total of 2196 patients with gastric cancer diagnosis and total or partial gastrectomy were identified in the registries. Of these patients, 2118 were applicable for this study. Cox proportional hazard models provided hazard ratios (HRs) with 95% CIs of 5-year OS. The results were adjusted for age, sex, year of operation, comorbidities, tumor location, pathologic stage, and neoadjuvant therapy.
The observed 5-year OS rates were 38.7% in patients with no or minor spleen injury, 39.7% in patients with splenectomy due to injury, and 30.8% in patients with splenectomy due to oncologic reasons (P = .032). Patients who underwent R0 gastrectomy with splenectomy due to oncologic reasons had higher 5-year mortality (the adjusted model HR, 1.26; 95% CI, 1.01-1.56) than patients who underwent spleen preservation.
The OS was worst in patients who underwent gastrectomy with splenectomy due to oncologic reasons, highlighting the poor prognosis in patients with advanced gastric cancer. Splenectomy due to injury does not compromise the prognosis.
目前尚无全国性研究比较因损伤或肿瘤原因行全胃或部分胃切除联合脾切除术后的长期生存率，也没有关于保留脾脏的研究。本研究旨在探讨在全国范围内基于人群的情况下，因损伤或肿瘤原因行全胃或部分胃切除联合脾切除或保留脾脏的胃腺癌患者的5年总生存率（OS）。
本研究纳入了2005年至2016年在芬兰因胃腺癌行全胃或部分胃切除联合脾切除或保留脾脏的所有患者，随访至2019年12月31日。在登记处共识别出2196例诊断为胃癌并接受全胃或部分胃切除的患者。其中，2118例患者适用于本研究。Cox比例风险模型提供了5年OS的风险比（HR）及95%置信区间（CI）。结果根据年龄、性别、手术年份、合并症、肿瘤位置、病理分期和新辅助治疗进行了调整。
无或轻度脾损伤患者的观察到的5年OS率为38.7%，因损伤行脾切除的患者为39.7%，因肿瘤原因行脾切除的患者为30.8%（P = 0.032）。因肿瘤原因行R0胃切除联合脾切除的患者5年死亡率高于保留脾脏的患者（校正模型HR，1.26；95%CI，1.01 - 1.56）。
因肿瘤原因行胃切除联合脾切除的患者OS最差，突出了晚期胃癌患者的预后不良。因损伤行脾切除不会影响预后。
