Abstract
Background
Splenic hilar lymphadenectomy is not recommended for advanced proximal gastric cancer
that does not invade the greater curvature according to the results of the previous
studies. The efficacy of splenic hilar lymphadenectomy for type II and type III adenocarcinomas
of the esophagogastric junction and easy spread to the greater curvature of the stomach
remains unclear. This study aimed to investigate the efficacy of splenic hilar lymphadenectomy
and identify the risk factors for metastasis to splenic hilar nodes.
Methods
We examined patients who underwent R0/1 gastrectomy for Siewert types II and III at
a single high–volume center in Japan. We analyzed the metastatic incidence, therapeutic
value index, and risk factors for splenic hilar lymph node metastasis.
Results
We examined 126 patients (74, type II; 52, type III). Splenectomy was performed in
76 patients. Metastatic incidence and the therapeutic value index of splenic hilar
lymph nodes in patients with type II and type III tumors were 4.5% and 0, and 21.9%
and 9.4, respectively. In the patients who underwent splenectomy, we identified Siewert
type III tumors (odds ratio: 6.93, 95% confidence interval: 1.24–38.8, p = 0.027)
and tumor location other than the lesser curvature (odds ratio: 7.36, 95% confidence
interval: 1.32–41.1, p = 0.023) to be independent risk factors. The metastatic incidence
(46.2%) and therapeutic value index (15.4) were high in patients with both risk factors.
Conclusions
Splenic hilar lymphadenectomy may contribute to the survival of patients with Siewert
type III tumors, especially when the predominant location is not the lesser curvature.
Keywords
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Article info
Publication history
Published online: July 09, 2022
Accepted:
July 6,
2022
Received in revised form:
July 5,
2022
Received:
November 21,
2021
Identification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
