Takahashi M, Fujimoto S, Kobayashi K, Takai M, Endoh F, Ohkubo H
Division of Surgery, Social Insurance Funabashi Central Hospital, Japan.
Hepatogastroenterology. 1995 Jul;42(3):230-3.
This study analyzed intraoperative indication for splenectomy at the time of total gastrectomy, based on 249 gastric cancer patients. Data on these patients were studied with special reference to the relationship between intraoperative gross findings such as serosal invasion, tumor size, histologic patterns and nodal metastasis to the splenic hilus. Fifty-three of the 249 patients (21.3%) had a positive metastasis. The incidence of nodal metastasis to the splenic hilus was high in patients with a primary lesion in the entire stomach (26/72: 36.1%). In case of no serosal invasion of the primary lesion, there was no nodal involvement to the splenic hilus (0/42). The low incidence of nodal metastasis occurred in case of a tumor size of less than 40 mm in the largest diameter (1/60: 1.7%) and with histological findings of signet ring cell carcinoma (1/19: 5.3%). Although site and size of the primary tumor, depth of tumor penetration, and histologic findings are interdependent variables, these factors indicate probable nodal involvement to the splenic hilus and unnecessary splenectomy can be avoided.
