Splenectomy in proximal gastric cancer: Frequency of lymph node metastasisto the splenic hilus

Background and Objectives: The indication for splenectomy in proximal gastr ic cancer remains controversial. Splenectomy is performed because of possib le lymph node metastasis of the splenic hilus or infiltration/metastasis of the spleen. The purpose of this study was to investigate the frequency of lymph node metastasis to the splenic hilus and metastasis to the spleen in proximal gastric carcinomas. Methods: In a morphologic study, the frequency of lymph node metastasis to the splenic hilus in 112 patients with proximal gastric cancer was investig ated with particular emphasis on its correlation with established clinicopa thological characteristics and classifications. Seventy-seven gastrectomy s pecimens were obtained from men and 35 from women. Patients ranged in age f rom 20 to 89 years (median 60 years). All patients underwent a potential cu rative resection (RO resection) with total gastrectomy and pancreas-preserv ing splenectomy. None of the patients had been treated preoperatively with cytotoxic drugs or radiation. Results: A mean number of three lymph nodes (range 0-8) in the splenic hilu s was found in each specimen. The incidence of lymph node metastasis of the splenic hilus was 9.8% (n = 11). Lymph node metastasis was only observed i n advanced proximal gastric cancer (UICC IIIb/IV) located at the greater cu rvature and in Borrmann type III/IV cancer with advanced lymph node metasta sis. An infiltration of the spleen was seen only in two cases with advanced stages of gastric carcinoma (stage IV). Conclusions: Based on our data lymph node metastasis to the splenic hilus i s rarely observed in proximal gastric cancer and only found in advanced can cer (UICC IIIb/IV) especially in tumors of the greater curvature and of Bor rmann type IV cancer. (C) 2001 Wiley-Liss, Inc.