Browse > Article
http://dx.doi.org/10.5230/jgc.2020.20.e8

Disadvantages of Complete No. 10 Lymph Node Dissection in Gastric Cancer and the Possibility of Spleen-Preserving Dissection: Review  

Toriumi, Tetsuro (Division of Gastric Surgery, Shizuoka Cancer Center)
Terashima, Masanori (Division of Gastric Surgery, Shizuoka Cancer Center)
Publication Information
Journal of Gastric Cancer / v.20, no.1, 2020 , pp. 1-18 More about this Journal
Abstract
Splenic hilar lymph node dissection has been the standard treatment for advanced proximal gastric cancer. Splenectomy is typically performed as part of this procedure. However, splenectomy has some disadvantages, such as increased risk of postoperative complications, especially pancreatic fistula. Moreover, patients who underwent splenectomy are vulnerable to potentially fatal infection caused by encapsulated bacteria. Furthermore, several studies have shown an association of splenectomy with cancer development and increased risk of thromboembolic events. Therefore, splenectomy should be avoided if it does not confer a distinct oncological advantage. Most studies that compared patients who underwent splenectomy and those who did not failed to demonstrate the efficacy of splenectomy. Based on the results of a randomized controlled trial conducted in Japan, prophylactic dissection with splenectomy is no longer recommended in patients with gastric cancer with no invasion of the greater curvature. However, patients with greater curvature invasion or those with remnant gastric cancer still need to undergo splenectomy to facilitate splenic hilar node dissection. Spleen-preserving splenic hilar node dissection is a new procedure that may help delink splenic hilar node dissection and splenectomy. In this review, we examine the evidence pertaining to the efficacy and disadvantages of splenectomy. We discuss the possibility of spleen-preserving surgery for prophylactic splenic hilar node dissection to overcome the disadvantages of splenectomy.
Keywords
Gastric cancer; Lymph node dissection; Splenectomy; Review;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Oh SJ, Hyung WJ, Li C, Song J, Kang W, Rha SY, et al. The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer. J Surg Oncol 2009;99:275-280.   DOI
2 Son SY, Shin DJ, Park YS, Oo AM, Jung DH, Lee CM, et al. Spleen-preserving lymphadenectomy versus splenectomy in laparoscopic total gastrectomy for advanced gastric cancer. Surg Oncol 2017;26:207-211.   DOI
3 Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 2006;93:559-563.   DOI
4 Shen JG, Cheong JH, Hyung WJ, Kim J, Choi SH, Noh SH. Adverse effect of splenectomy on recurrence in total gastrectomy cancer patients with perioperative transfusion. Am J Surg 2006;192:301-305.   DOI
5 Sun LM, Chen HJ, Jeng LB, Li TC, Wu SC, Kao CH. Splenectomy and increased subsequent cancer risk: a nationwide population-based cohort study. Am J Surg 2015;210:243-251.   DOI
6 Davies JM, Lewis MP, Wimperis J, Rafi I, Ladhani S, Bolton-Maggs PH. Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: prepared on behalf of the British Committee for Standards in Haematology by a working party of the Haemato-Oncology task force. Br J Haematol 2011;155:308-317.   DOI
7 Mellemkjoer L, Olsen JH, Linet MS, Gridley G, McLaughlin JK. Cancer risk after splenectomy. Cancer 1995;75:577-583.   DOI
8 Linet MS, Nyren O, Gridley G, Mellemkjaer L, McLaughlin JK, Olsen JH, et al. Risk of cancer following splenectomy. Int J Cancer 1996;66:611-616.   DOI
9 Zhu GL, Sun Z, Wang ZN, Xu YY, Huang BJ, Xu Y, et al. Splenic hilar lymph node metastasis independently predicts poor survival for patients with gastric cancers in the upper and/or the middle third of the stomach. J Surg Oncol 2012;105:786-792.   DOI
10 Kunisaki C, Makino H, Suwa H, Sato T, Oshima T, Nagano Y, et al. Impact of splenectomy in patients with gastric adenocarcinoma of the cardia. J Gastrointest Surg 2007;11:1039-1044.   DOI
11 Ishikawa S, Shimada S, Miyanari N, Hirota M, Takamori H, Baba H. Pattern of lymph node involvement in proximal gastric cancer. World J Surg 2009;33:1687-1692.   DOI
12 Huang CM, Zhang JR, Zheng CH, Li P, Xie JW, Wang JB, et al. A 346 case analysis for laparoscopic spleen-preserving no.10 lymph node dissection for proximal gastric cancer: a single center study. PLoS One 2014;9:e108480.   DOI
13 Shin SH, Jung H, Choi SH, An JY, Choi MG, Noh JH, et al. Clinical significance of splenic hilar lymph node metastasis in proximal gastric cancer. Ann Surg Oncol 2009;16:1304-1309.   DOI
14 Jeong O, Jung MR, Ryu SY. Clinicopathological features and prognostic impact of splenic hilar lymph node metastasis in proximal gastric carcinoma. Eur J Surg Oncol 2019;45:432-438.   DOI
15 Pommerening MJ, Rahbar E, Minei K, Holcomb JB, Wade CE, Schreiber MA, et al. Splenectomy is associated with hypercoagulable thrombelastography values and increased risk of thromboembolism. Surgery 2015;158:618-626.   DOI
16 Saji S, Sakamoto J, Teramukai S, Kunieda K, Sugiyama Y, Ohashi Y, et al. Impact of splenectomy and immunochemotherapy on survival following gastrectomy for carcinoma: covariate interaction with immunosuppressive acidic protein, a serum marker for the host immune system. Surg Today 1999;29:504-510.   DOI
17 Cho MY, Kroh MD, Joh YG, Suh SO. Impact of splenectomy on circulating T-lymphocyte subsets in stage III gastric cancer. ANZ J Surg 2002;72:411-416.   DOI
18 Pan D, Chen H, Li LQ, Li ZF. Effect of splenectomy combined with resection for gastric carcinoma on patient prognosis. Med Sci Monit 2016;22:4205-4209.   DOI
19 Chen XL, Yang K, Zhang WH, Chen XZ, Zhang B, Chen ZX, et al. Metastasis, risk factors and prognostic significance of splenic hilar lymph nodes in gastric adenocarcinoma. PLoS One 2014;9:e99650.   DOI
20 Kosuga T, Ichikawa D, Okamoto K, Komatsu S, Shiozaki A, Fujiwara H, et al. Survival benefits from splenic hilar lymph node dissection by splenectomy in gastric cancer patients: relative comparison of the benefits in subgroups of patients. Gastric Cancer 2011;14:172-177.   DOI
21 Kang CM, Chung YE, Jung MJ, Hwang HK, Choi SH, Lee WJ. Splenic vein thrombosis and pancreatic fistula after minimally invasive distal pancreatectomy. Br J Surg 2014;101:114-119.   DOI
22 Mukherjee D, Lidor AO, Chu KM, Gearhart SL, Haut ER, Chang DC. Postoperative venous thromboembolism rates vary significantly after different types of major abdominal operations. J Gastrointest Surg 2008;12:2015-2022.   DOI
23 Boyle S, White RH, Brunson A, Wun T. Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia. Blood 2013;121:4782-4790.   DOI
24 Han JW, Kong SH, Shin CI, Min SK, Min SI, Kim TH, et al. Portomesenteric vein thrombosis after gastric surgery. Gastric Cancer 2016;19:1135-1143.   DOI
25 Sasada S, Ninomiya M, Nishizaki M, Harano M, Ojima Y, Matsukawa H, et al. Frequency of lymph node metastasis to the splenic hilus and effect of splenectomy in proximal gastric cancer. Anticancer Res 2009;29:3347-3351.
26 Hong ZL, Chen QY, Zheng CH, Li P, Xie JW, Wang JB, et al. A preoperative scoring system to predict the risk of No.10 lymph node metastasis for advanced upper gastric cancer: a large case report based on a single-center study. Oncotarget 2017;8:80050-80060.   DOI
27 Li P, Huang CM, Zheng CH, Xie JW, Wang JB, Lin JX, et al. Laparoscopic spleen-preserving splenic hilar lymphadenectomy in 108 consecutive patients with upper gastric cancer. World J Gastroenterol 2014;20:11376-11383.   DOI
28 Aoyagi K, Kouhuji K, Miyagi M, Imaizumi T, Kizaki J, Shirouzu K. Prognosis of metastatic splenic hilum lymph node in patients with gastric cancer after total gastrectomy and splenectomy. World J Hepatol 2010;2:81-86.   DOI
29 Ito H, Inoue H, Odaka N, Satodate H, Mukai S, Omoto T, et al. Prognostic impact of prophylactic splenectomy for upper-third gastric cancer: a cohort study. Anticancer Res 2013;33:277-282.
30 Huang CM, Wang JB, Lu HS, Zheng CH, Li P, Xie JW, et al. Prognostic impact of splenectomy on advanced proximal gastric cancer with No. 10 lymph node metastasis. Chin Med J (Engl) 2009;122:2757-2762.
31 Maezawa Y, Aoyama T, Yamada T, Kano K, Hayashi T, Sato T, et al. Priority of lymph node dissection for proximal gastric cancer invading the greater curvature. Gastric Cancer 2018;21:569-572.   DOI
32 Watanabe M, Kinoshita T, Enomoto N, Shibasaki H, Nishida T. Clinical significance of splenic hilar dissection with splenectomy in advanced proximal gastric cancer: an analysis at a single institution in Japan. World J Surg 2016;40:1165-1171.   DOI
33 Lee KY, Noh SH, Hyung WJ, Lee JH, Lah KH, Choi SH, et al. Impact of splenectomy for lymph node dissection on long-term surgical outcome in gastric cancer. Ann Surg Oncol 2001;8:402-406.   DOI
34 Kasakura Y, Fujii M, Mochizuki F, Kochi M, Kaiga T. Is there a benefit of pancreaticosplenectomy with gastrectomy for advanced gastric cancer? Am J Surg 2000;179:237-242.   DOI
35 Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995;345:745-748.   DOI
36 Erturk S, Ersan Y, Cicek Y, Dogusoy G, Senocak M. Effect of simultaneous splenectomy on the survival of patients undergoing curative gastrectomy for proximal gastric carcinoma. Surg Today 2003;33:254-258.   DOI
37 Otsuji E, Yamaguchi T, Sawai K, Okamoto K, Takahashi T. Total gastrectomy with simultaneous pancreaticosplenectomy or splenectomy in patients with advanced gastric carcinoma. Br J Cancer 1999;79:1789-1793.   DOI
38 Wang F, Chang YC, Chen TH, Hsu JT, Kuo CJ, Lin CJ, et al. Prognostic significance of splenectomy for patients with gastric adenocarcinoma undergoing total gastrectomy: a retrospective cohort study. Int J Surg 2014;12:557-565.   DOI
39 Otsuji E, Yamaguchi T, Sawai K, Ohara M, Takahashi T. End results of simultaneous splenectomy in patients undergoing total gastrectomy for gastric carcinoma. Surgery 1996;120:40-44.   DOI
40 Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. Lancet 1996;347:995-999.   DOI
41 Kodera Y, Sasako M, Yamamoto S, Sano T, Nashimoto A, Kurita A. Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg 2005;92:1103-1109.   DOI
42 Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy--Japan Clinical Oncology Group study 9501. J Clin Oncol 2004;22:2767-2773.   DOI
43 Yura M, Yoshikawa T, Otsuki S, Yamagata Y, Morita S, Katai H, et al. The therapeutic survival benefit of splenic hilar nodal dissection for advanced proximal gastric cancer invading the greater curvature. Ann Surg Oncol 2019;26:829-835.   DOI
44 Ohkura Y, Haruta S, Shindoh J, Tanaka T, Ueno M, Udagawa H. Efficacy of prophylactic splenectomy for proximal advanced gastric cancer invading greater curvature. World J Surg Oncol 2017;15:106.   DOI
45 Holdsworth RJ, Irving AD, Cuschieri A. Postsplenectomy sepsis and its mortality rate: actual versus perceived risks. Br J Surg 1991;78:1031-1038.   DOI
46 Usui S, Tashiro M, Haruki S, Arita K, Ito K, Matsumoto A, et al. Spleen preservation versus splenectomy in laparoscopic total gastrectomy with D2 lymphadenectomy for gastric cancer: a comparison of short-term outcomes. Asian J Endosc Surg 2016;9:5-13.   DOI
47 Zhang CH, Zhan WH, He YL, Chen CQ, Huang MJ, Cai SR. Spleen preservation in radical surgery for gastric cardia cancer. Ann Surg Oncol 2007;14:1312-1319.   DOI
48 Huang CM, Chen T, Lin JX, Chen QY, Zheng CH, Li P, et al. The effects of laparoscopic spleen-preserving splenic hilar lymphadenectomy on the surgical outcome of proximal gastric cancer: a propensity score-matched, case-control study. Surg Endosc 2017;31:1383-1392.   DOI
49 Son SY, Kong SH, Ahn HS, Park YS, Ahn SH, Suh YS, et al. The value of N staging with the positive lymph node ratio, and splenectomy, for remnant gastric cancer: a multicenter retrospective study. J Surg Oncol 2017;116:884-893.   DOI
50 Honda S, Bando E, Makuuchi R, Tokunaga M, Tanizawa Y, Kawamura T, et al. Effects of initial disease status on lymph flow following gastrectomy in cases of carcinoma in the remnant stomach. Gastric Cancer 2017;20:457-464.   DOI
51 Zakeri S, Gorji N, Akhtari M, Moeini R. Splenectomy may have more complications than currently proven. Med Hypotheses 2018;112:43-46.   DOI
52 Theilacker C, Ludewig K, Serr A, Schimpf J, Held J, Bogelein M, et al. Overwhelming postsplenectomy infection: a prospective multicenter cohort study. Clin Infect Dis 2016;62:871-878.   DOI
53 Davidson RN, Wall RA. Prevention and management of infections in patients without a spleen. Clin Microbiol Infect 2001;7:657-660.   DOI
54 Kristinsson SY, Gridley G, Hoover RN, Check D, Landgren O. Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. Haematologica 2014;99:392-398.   DOI
55 Sano T, Sasako M, Mizusawa J, Yamamoto S, Katai H, Yoshikawa T, et al. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma. Ann Surg 2017;265:277-283.   DOI
56 Uyama I, Sugioka A, Sakurai Y, Komori Y, Hanai T, Matsui H, et al. Hand-assisted laparoscopic function- preserving and radical gastrectomies for advanced-stage proximal gastric cancer. J Am Coll Surg 2004;199:508-515.   DOI
57 Huang CM, Chen QY, Lin JX, Zheng CH, Li P, Xie JW. Huang's three-step maneuver for laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer. Chin J Cancer Res 2014;26:208-210.
58 Ji X, Fu T, Bu ZD, Zhang J, Wu XJ, Zong XL, et al. Comparison of different methods of splenic hilar lymph node dissection for advanced upper- and/or middle-third gastric cancer. BMC Cancer 2016;16:765.   DOI
59 Sugita H, Oda E, Hirota M, Ishikawa S, Tomiyasu S, Tanaka H, et al. Significance of lymphadenectomy with splenectomy in radical surgery for advanced (pT3/pT4) remnant gastric cancer. Surgery 2016;159:1082-1089.   DOI
60 Ohashi M, Morita S, Fukagawa T, Kushima R, Katai H. Surgical treatment of non-early gastric remnant carcinoma developing after distal gastrectomy for gastric cancer. J Surg Oncol 2015;111:208-212.   DOI
61 Jeong O, Kim HG, Ryu SY, Park YK, Jung MR. Adverse prognostic impact of splenectomy on survival in gastric carcinoma patients: regression and propensity score matching analysis of 1074 patients. PLoS One 2018;13:e0203820.   DOI
62 Li C, Kim S, Lai JF, Oh SJ, Hyung WJ, Choi WH, et al. Lymph node dissection around the splenic artery and hilum in advanced middle third gastric carcinoma. Eur J Surg Oncol 2009;35:709-714.   DOI
63 Qin H, Lin C. Radical resection of gastric carcinoma with pancreas and spleen preservation and functional cleaning of lymph nodes. Chin Med J (Engl) 2002.115:736-739.   DOI
64 Fatouros M, Roukos DH, Lorenz M, Arampatzis I, Hottentrott C, Encke A, et al. Impact of spleen preservation in patients with gastric cancer. Anticancer Res 2005;25:3023-3030.
65 Kwon SJ. Prognostic impact of splenectomy on gastric cancer: results of the Korean Gastric Cancer Study Group. World J Surg 1997;21:837-844.   DOI
66 Csendes A, Burdiles P, Rojas J, Braghetto I, Diaz JC, Maluenda F. A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma. Surgery 2002;131:401-407.   DOI
67 Kinoshita T, Shibasaki H, Enomoto N, Sahara Y, Sunagawa H, Nishida T. Laparoscopic splenic hilar lymph node dissection for proximal gastric cancer using integrated three-dimensional anatomic simulation software. Surg Endosc 2016;30:2613-2619.   DOI
68 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011;14:101-112.   DOI
69 Toge T, Kameda A, Kuroi K, Seto Y, Yamada H, Hattori T. The role of the spleen in immunosuppression and the effects of splenectomy on prognosis in gastric cancer patients. Nippon Geka Gakkai Zasshi 1985;86:1120-1123.
70 Galizia G, Lieto E, De Vita F, Castellano P, Ferraraccio F, Zamboli A, et al. Modified versus standard D2 lymphadenectomy in total gastrectomy for nonjunctional gastric carcinoma with lymph node metastasis. Surgery 2015;157:285-296.   DOI
71 Zhang H, Pang D, Xu H, Ren Y, Liu C. Is concomitant splenectomy beneficial for the long-term survival of patients with gastric cancer undergoing curative gastrectomy? A single-institution study. World J Surg Oncol 2014;12:193.   DOI
72 Nashimoto A, Yabusaki H, Matsuki A. The significance of splenectomy for advanced proximal gastric cancer. Int J Surg Oncol 2012;2012:301530.   DOI
73 Verlato G, Roviello F, Marchet A, Giacopuzzi S, Marrelli D, Nitti D, et al. Indexes of surgical quality in gastric cancer surgery: experience of an Italian network. Ann Surg Oncol 2009;16:594-602.   DOI