PROGNOSTIC IMPACT OF SPLENECTOMY ON GASTRIC-CANCER - RESULTS OF THE KOREAN GASTRIC-CANCER STUDY-GROUP

The relation between splenectomy and survival time after curative tota l gastrectomy for gastric cancer was reviewed retrospectively on 492 p atients treated at nine hospitals between 1989 and 1993. Altogether 26 0 patients underwent splenectomy, and 232 patients did not. A univaria te analysis revealed that the survival time of patients with splenecto my was significantly less than those without splenectomy (p = 0.0265). In a subgroup of our patients stratified to adjust for the stage of d isease, there was no significant difference between the survival rates . Splenectomy remained insignificant according to the multivariate ana lysis using Cox's proportional-hazard regression. The splenectomy grou p was associated with more risk factors (e.g., T3/T4 tumors, positive nodes, stage greater than III, large tumor size) that are powerful pre dictors of death due to gastric cancer. In a separate multivariate ana lysis after eliminating those who had a T4 tumor invasion or a N2 noda l positivity from the analysis (or both), splenectomy again remained i nsignificant. In conclusion, we could not find any beneficial effect o f splenectomy in gastric cancer patients in this retrospective multiva riate analysis. We can presume that splenectomy cannot increase the su rvival rate so long as the splenectomy group has more risk factors tha n the nonsplenectomy group. Therefore randomized prospective clinical trials using more precise criteria to indicate the need for splenectom y are needed to assess whether splenectomy is beneficial.