IS IT NECESSARY TO PERFORM A SPLENECTOMY EN PRINCIPE IN RADICAL GASTRECTOMY WITH SYSTEMATIC LYMPHADENECTOMY IN GASTRIC-CARCINOMA

In order to screen the necessity of splenectomy ''en principe'' we eva luated all patients suffering from gastric carcinoma between Jan. 1988 - Apr. 1993 retrospectively. In total a group of 318 patients were tr eated and from these 261 patients were operated (resection rate 82%). In 30% of the patients (77 pat.) we performed a subtotal distal gastre ctomy and in 70% (184 pat.) a radical gastrectomy with a D2-lymphadene ctomy. The splenectomy rate in the group of gastrectomy was 94% (173 p at.). In total 13% of the lymph nodes of the hilus of the spleen were Infiltrated and an additional metastasis of the spleen was found in 1% . In carcinomas located at the minor curvature 13% had an infiltration of the lymph node station 10, in carcinomas located at the greater cu rvature in 17% and in carcinomas with a diffuse tumor growth in 10% re spectively. Patients with a tumor located in the proximal stomach had an infiltration of the lymph nodes in 14% and in carcinomas of the ant rum in 7% respectively. None of the patients having a UICC stage VII h ad an infiltration of the lymph nodes at the hilus of the spleen, but 25% of the patients having a UICC stage III/IV. 2 patients from the la tter group had an additional metastasis of the spleen. Conclusion: The indication of splenectomy is given only in advanced proximal tumor lo cations, especially in tumors of the greater curvature. In the early t umor stages and in the distal locations of gastric carcinoma it might be useful to perform a selective lymph node dissection of the hilus of the spleen in order to increase the completeness of the radical gastr ectomy.