Comparative Study Of The Surgical Efficacy Of Splenectomy And Splenic Preservation In Patients With Advanced Proximal Gastric Cancer

Objective:To compare the surgical efficacy of splenectomy versus splenic preservation in the treatment of patients with advanced proximal gastric cancer.Methods:A total of 91 patients with advanced gastric proxima cancer since January 2008 to May 2010 in our department were enrolled,including 48 cases in TG(Total gastreotomy) group and 43 cases in TGS(Total gastreotomy plus splenectomy) group. The general information,operation details, the results of postoperative complications and lymph node dissection between the two groups were analyzed and compared. The long-term efficacy was followed up.Results:The surgical procedures was longer in TG group, and the postoperative length of stay was longer in TGS group, with statistical significance differences(P<0.05).The rate of postoperative complications was higher(67.44% vs. 45.83%,P<0.05) in TGS group versus TG group,especially,in the comparison of septic complications(51.16% vs. 29.17%,P<0.05).The operative mortality and the reoperation rate were similarbetween the two groups(P>0.05).There was no significant difference in the mean number of No.10 and No.11 lymph nodes harvested, the metastatic lymph node ratio and the positive rate of the patients between the two groups(P>0.05).The 1-year,3-year,5-year disease free survival rates(DFS)in TG group were 76.9%, 45.8%, 36.7%,while those in TGS group were 81.0%, 49.2%, 41.4%, without statistically significant differences(P>0.05). There was no significant difference in Kaplan-Meier survival curves between two groups(P>0.05).Conclusion:With lower postoperative complications rate, spleen preserving lymphadenectomy has the same effect on lymph node dissection as splenectomy, for the patients with advanced gastric proximal cancer. There was no statistical difference in long-term survival between the two groups. The spleen preserving lymphadenec tomy is worth promoting clinically.