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PubMed1975

Platelet kinetics in idiopathic thrombocytopenic purpura (ITP) before and at different times after splenectomy.

Platelet kinetics were studied in 18 patients with idiopathic thrombocytopenic purpura (ITP) before splenectomy, 1 month and 8 months after splenectomy. A gamma function was used for the calculation of platelet mean life span (MLS). Before splenectomy platelet MLS was greatly reduced and platelet production was 2.8 times normal. The peripheral platelet count and platelet recovery were significantly related to platelet MLS. One month after splenectomy platelet MLS increased appreciably while platelet production decreased but continued to be significantly above normal. These changes together with the removal of the splenic platelet pool resulted in a peripheral platelet count significantly higher than normal and a total platelet mass not differing from normal. Eight months after splenectomy platelet MLS increased slightly but was not significantly different from that found 1 month after splenectomy. Platelet production, however, decreased significantly and became normal. This resulted in a normal peripheral platelet count and a decreased total platelet mass which was significantly lower than in non-splenectomized control subjects. The results suggest that platelet production is regulated by a feed-back mechanism that is governed by the peripheral platelet count. The high platelet count encountered 1 month after splenectomy is due to a sluggishness of this regulatory mechanism.

Adolescent↗

PubMed1992

Antibody responses following splenectomy: implications for the timing of prophylactic vaccination.

Antibody responses are reduced both in the short- and long-term after splenectomy. It is not known if this reduction is more profound in the immediate postoperative period compared to later, and consequently, whether there would be an advantage in delaying prophylactic vaccination to ensure a greater antibody response. To investigate this, the effect of splenectomy on the primary and secondary antibody response to sheep red blood cells (SRBC) injected into the peritoneum (IP) of adult male Porton rats was measured after either splenectomy (Spx), sham splenectomy (Sham), anaesthesia only (Ans) or no procedure at all (Con). There was no difference in the titres of antibody between the Con and the Ans rats. There was no difference in the titres of antibody between the Sham and Spx rats, but both had significantly lower titres than the Con rats. In a separate experiment, rats were immunized 1 month or 1 year after splenectomy or sham-splenectomy. One month after the operation the antibody response of the Sham rats had increased and did not differ from that of Con rats, but in rats which had been splenectomized there was a long-term suppression of the antibody response, which did not improve for at least one year. The results suggest that, in patients requiring splenectomy for trauma and not able to be vaccinated before operation, there may be no advantage in delaying prophylactic vaccination postoperatively.

Animals↗

PubMed1977

Splenectomy in chronic lymphocytic leukaemia.

In a retrospective study it was endeavoured to evaluate the effects of splenectomy in chronic lymphocytic leukaemia (CLL) characterised by splenomegaly. The material comprises 42 patients subjected to the operation in the course of the past 20 years. In the majority the spleen weighed more than 1000 g. The main indication for splenectomy was anaemia, while in 9 cases it was thrombocytopenia and in 14 cases hypercatabolism. Splenectomy is followed by a pronounced increase in the venous haemoglobin level and platelet count to higher values which have been recorded for up to 3 years after the procedure. In cases where data were available, there has been weight gain and a falling basal metabolic rate. Splenectomy is effective especially in cases predominated exclusively by splenomegaly, but even in cases with marked extrasplenic manifestations, splenectomy often greatly reduces the need for prednisone and cytostatics. Increasing hepatomegaly and lymphomas were not more common after splenectomy than in a control series, and the incidence of infections was not increased after the operation. For comparison, 37 non-splenectomised patients with splenomegaly were assessed. X-radiation of the spleen seems to be insufficient, since usually it has to be repeated. Splenomegaly does not decrease spontaneously and rarely after treatment with prednisone/cytostatics. The findings indicate that splenectomy of patients with CLL and increasing splenomegaly should be performed more often and presumably also earlier than recommended in the literature.

Adrenal Cortex Hormones↗

PubMed1987

Immunological profile after splenectomy in children with beta-thalassaemia major.

The in vitro immune functions of peripheral blood lymphocytes have been studied in 12 children with beta-thalassaemia major and hypersplenism. The study was performed prior to splenectomy and on the 2nd, 6th, 15th and 30th day after splenectomy. It was found that before splenectomy, patients had low numbers of blood leucocytes, normal rosette and T3 lymphocyte counts, low T4 and normal T8 lymphocyte counts with a T4/T8 ratio below 2, impaired T lymphocyte mitogenic responses induced by PHA, increased numbers of polyvalent and monovalent B lymphocytes and normal immunoglobulin levels of IgG and IgA. After splenectomy, especially on the 2nd day, leucocytosis, a significant decrease of T cells and their subsets and a reduction of the IgM levels were found. These parameters, except the IgM levels, increased until the 30th day after splenectomy and reached presplenectomy values. On the 2nd day after splenectomy, large mononuclear cells behaving like immunocytes appeared in the peripheral blood. They had the phenotype of T3, T4, T8, B lymphocytes and OKM1 monocytes. All the large mononuclear cells increased significantly on the 6th day after splenectomy and remained elevated during the whole study (30 days). The T4/T8 ratio was increased, but no increase was found in the functional responses of T lymphocytes.

Adolescent↗

PubMedDate not supplied

CD4 lymphocyte numbers after splenectomy in patients infected with the human immunodeficiency virus.

Splenectomy has been reported to alter inconsistently the CD4 lymphocyte numbers in patients infected with the human immunodeficiency virus (HIV). To further assess the effect of splenectomy we have retrospectively examined the charts of 10 patients who were infected with HIV and who had undergone splenectomy. There was a significant increase in the mean CD4 numbers following splenectomy (mean increase of 326/microliters, or 2.1-fold, P = 0.0009), the total lymphocyte numbers (mean increase of 1.55/ml, or 2.2-fold, P = 0.001) and in the CD8 lymphocyte count (mean increase of 968/microliters, or 2.3-fold, P = 0.014). No significant difference was observed in the percentage CD4 lymphocytes (P = 0.95) or in the CD4:CD8 lymphocyte ratio (P = 0.76). In two patients, symptoms suggestive of impaired immune function developed post-splenectomy, at a time when their CD4 lymphocyte numbers were markedly higher than their pre-splenectomy values. One developed oral candidiasis (CD4 960/microliters, percentage CD4 32%), and in one patient a 7 kg weight loss was associated with recurrent mouth ulcers (CD4 680/microliters, percentage CD4 7%). We conclude that the total CD4 count increases significantly after splenectomy while the percentage CD4 lymphocyte count and CD4:CD8 lymphocyte ratio do not. Our data suggest that the CD4 lymphocyte count overestimates the immune function in these patients, although our findings are not conclusive.

CD4-CD8 Ratio↗

PubMed2004

Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications.

Splenectomy has been a standard treatment for adult patients with idiopathic thrombocytopenic purpura (ITP) for more than 50 years. However, the durability of responses, the ability to predict who will respond, and the frequency of surgical complications with splenectomy all remain uncertain. To better interpret current knowledge we systematically identified and reviewed all 135 case series, 1966 to 2004, that described 15 or more consecutive patients who had splenectomy for ITP and that had data for 1 of these 3 outcomes. Complete response was defined as a normal platelet count following splenectomy and for the duration of follow-up with no additional treatment. Forty-seven case series reported complete response in 1731 (66%) of 2623 adult patients with follow-up for 1 to 153 months; complete response rates did not correlate with duration of follow-up (r = -0.103, P = .49). None of 12 preoperative characteristics that have been reported consistently predicted response to splenectomy. Mortality was 1.0% (48 of 4955 patients) with laparotomy and 0.2% (3 of 1301 patients) with laparoscopy. Complication rates were 12.9% (318 of 2465) with laparotomy and 9.6% (88 of 921 patients) with laparoscopic splenectomy. Although the risk of surgery is an important consideration, splenectomy provides a high frequency of durable responses for adult patients with ITP.

Adult↗

PubMed2001

Long-term evaluation of the beneficial effect of subtotal splenectomy for management of hereditary spherocytosis.

Clinical manifestations of hereditary spherocytosis (HS) can be abrogated by splenectomy. However, concerns exist regarding exposure of patients to a lifelong risk for overwhelming infections and, to a lesser extent, to vascular complications after total splenectomy. In the search for alternative treatment modalities, we assessed, in a previous pilot study, the potential usefulness of subtotal splenectomy in a small population of patients. During a mean follow-up period of 3.5 years, subtotal splenectomy was shown to be effective in decreasing the hemolytic rate, while maintaining the phagocytic function of the spleen. In the current study, we evaluated the clinical and biologic features of 40 patients with HS who underwent subtotal splenectomy and were monitored for periods ranging from 1 to 14 years. The beneficial effect of subtotal splenectomy included a sustained decrease in hemolytic rate and a continued maintenance of phagocytic function of the splenic remnant. However, mild-to-moderate hemolysis was persistent and accounted for secondary gallstone formation and aplastic crisis in a small subset of patients. Surprisingly, regrowth of the remnant spleen did not seem to have a major impact on the beneficial outcomes of these individuals. Our results suggest that subtotal splenectomy appears to be a reasonable treatment option for management of patients with HS, especially young children.

Adolescent↗

PubMed1997

Case/control study of the role of splenectomy in chronic lymphocytic leukemia.

PURPOSE: This retrospective analysis was performed to evaluate critically the morbidity and mortality of splenectomy in patients with chronic lymphocytic leukemia and to determine the probability of hematologic response. Further, using a case/control format based on multivariate analysis-derived predictors of survival, we evaluated the influence of splenectomy on survival. PATIENTS AND METHODS: Between 1971 and 1993, 55 patients with chronic lymphocytic leukemia underwent splenectomy. They were compared with 55 fludarabine-treated patients who had been matched for age, serum albumin level, sex, hemoglobin level, Rai stage, number of prior therapies, and time from diagnosis. RESULTS: In the perioperative period, blood-product usage was modest, and common morbidities were limited to minor infections in 18% of the patients and pneumonia/atelectasis in 25%. Perioperative mortality was 9%. Deaths were related to septic complications in all cases and associated with a preoperative performance status > or = 2 (P = .05). The only predictor identified for hemoglobin and neutrophil increments was spleen weight (P < .05). No factors predictive of platelet increment were identified. The early death rate (within 30 days) and overall survival of splenectomy and control patients were not significantly different (P > .2). Among Rai stage IV patients, those who were splenectomized displayed a strong trend for improved overall survival (P = .15 by log-rank test). The 2-year actuarial survival rate of Rai stage IV patients was 51% +/- 9% in the splenectomy group and 28% +/- 9% in the control group. CONCLUSION: Splenectomy can be performed with modest morbidity, mortality, and resource utilization in patients with advanced chronic lymphocytic leukemia and significant cytopenias. The procedure results in major hematologic benefits in most patients, with hemoglobin and neutrophil increments correlated with spleen weight. Overall, the survival of splenectomized patients is equivalent to control patients. Thrombocytopenic patients (< 100 x 10(9)/L) are most likely to obtain hematologic benefit, and potentially enjoy improved survival. These patients would be suitable for a randomized study to establish definitively the role of splenectomy in chronic lymphocytic leukemia.

Adult↗

PubMed2004

Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer.

BACKGROUND: Splenectomy has been associated with increased morbidity after gastrectomy for gastric cancer. Resection of proximal versus distal tumors is associated with a higher morbidity. Because splenectomy is more commonly performed in resection of proximal tumors, these analyses may be biased. The aim of this study was to describe the association of splenectomy with complications in patients undergoing resection of proximal gastric and gastroesophageal junction (GEJ) cancers. METHODS: From July 1985 to August 2001, 335 patients underwent resection of proximal gastric or GEJ (type II and III) cancers. Clinical and pathologic factors were retrieved from a prospective database. RESULTS: Overall morbidity was 59% (infectious complications, 41%; noninfectious complications, 36%), and mortality was 4.5%. Splenectomy was associated with a higher rate of infectious complications (57% vs. 33%; P <.01) but not of noninfectious complications (39% vs. 34%; not significant) or mortality (4% vs. 5%; not significant). Splenectomy was also associated with a higher rate of infectious complications on multivariate analysis (hazard ratio, 2.4; P <.01). CONCLUSIONS: Morbidity after resection of proximal gastric and GEJ cancer is significant; splenectomy is associated with increased morbidity, but not mortality, in these patients. Because these complications can be managed without an increase in mortality, splenectomy should be performed when indicated by the extent of the tumor.

Adenocarcinoma↗

PubMed2005

[Intra-operative evaluation of portal pressure and immediate results of surgical treatment of portal hypertension in schistosomotic patients submitted to esophagogastric devascularization with splenectomy].

BACKGROUND: The main cause of portal hypertension in Brazil is the hepato-splenic form of mansonic schistosomiasis and the most employed technique for the surgical approach of this disease is the esophagogastric devascularization with splenectomy, generally associated to postoperative endoscopical esophageal varices sclerotherapy. The hemodynamic alterations after surgical treatment and its possible influence on the outcome are not well established. AIM: To evaluate the immediate impact of esophagogastric devascularization with splenectomy upon portal pressure as well as the results of the surgical treatment on digestive hemorrhage recurrence and on esophageal varices. METHODS: Nineteen patients with mean age of 37.9 years and portal hypertension and previous episodes of digestive hemorrhage caused by esophageal varices rupture due to hepato-splenic schistosomiasis were studied. None of the patients had received any treatment prior to the surgery and underwent to elective esophagogastric devascularization with splenectomy. Portal pressure was assessed at the beginning and at the end of esophagogastric devascularization with splenectomy through portal vein catheterization with a polyethylene catheter introduced through a jejunal branch vein. All patients were submitted to digestive endoscopy before and after the surgery, in order to classify the size of esophageal varices after esophagogastric devascularization with splenectomy according to Palmer's classification. RESULTS: In all patients the portal pressure had diminished with a mean decrease of 31.3% after esophagogastric devascularization with splenectomy. In the postoperative endoscopic follow-up (1 month), the esophageal varices showed a statistically significant reduction in their size, when compared to the pre-surgical measurements. CONCLUSION: These results have demonstrated that the esophagogastric devascularization with splenectomy promotes immediate decrease in the portal pressure and a consequent reduction in the esophageal varices size. We also observed that the risk of mortality and severe complications related to this technique is not insignificant.

Adolescent↗

PubMed2004

Laparoscopic splenectomy--a review.

Laparoscopic splenectomy has become the standard approach in many institutions when splenectomy is indicated for benign hematologic disease and has gained acceptance in patients with malignant hematologic disease and splenomegaly. It is a technically difficult procedure and is associated with a steep learning curve, with operative times initially longer than those associated with open splenectomy. However, technical advancements such as hand-assisted laparoscopic splenectomy have facilitated increased acceptance of laparoscopy as an approach that is superior to open splenectomy, even in patients with malignant hematologic disease and/or splenomegaly. When compared to open splenectomy, laparoscopic splenectomy is associated with shorter postoperative hospitalization and improved cosmesis.

Hematologic Diseases↗

PubMedDate not supplied

Efficacy of splenectomy for patients with mantle cell non-Hodgkin's lymphoma.

The purpose of this study was to define the role of splenectomy in patients (pts) with mantle cell lymphoma (MCL) with regard to improving cytopenias and symptoms of splenomegaly. 26 pts with MCL underwent splenectomy between January 1987 and October 1999 and were followed prospectively for hematologic response and operative morbidity and mortality. A positive response was defined at 1 month of follow-up as: a hemoglobin of > or = 1.0 g/dl in a pt with a preoperative value < 11.0 g/dl; or a platelet count of > or = 100 x 10(9)/L in a pt with a preoperative value < 100 x 10(9)/L. A positive hematologic response was achieved in 69.2% of pts with preoperative anemia, 90% with thrombocytopenia, and 50% with both anemia and thrombocytopenia. The peri- and post-operative morbidity were 3.8 and 19.2%, respectively, the operative mortality was 0%. The median duration of hospitalization was six days. Four (15.4%) pts have not required chemotherapy after splenectomy. Three of these four were previously untreated and they have maintained stable disease for eight years after splenectomy without chemotherapy. Eight additional pts did not require chemotherapy for > 13 months after splenectomy. These results suggest that splenectomy may provide durable remission in selected pts with refractory cytopenias or symptoms related to splenomegaly in pts with MCL. There is a subset of pts that have prolonged disease stabilization without the requirement for immediate chemotherapy after splenectomy.

Adult↗

PubMed2004

[Laparoscopic splenectomy in hematological diseases].

BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) is the most common indication for elective splenectomy. The laparoscopic approach has been used over the past ten years. AIM: To report our experience with laparoscopic splenectomy. PATIENTS AND METHODS: Retrospective review of 27 patients subjected to splenectomy due to hematological diseases. Among them, 17 patients (78% female, age range 17-70 years old) were subjected to a laparoscopic splenectomy. Eligibility criteria were the presence of benign disease, an informed consent by the patient, a spleen size of less than 20 cm by ultrasound and absence of previous surgery in the upper left quadrant. The rest of the patients were subjected to an open splenectomy. RESULTS: Seventy one percent of patients subjected to laparoscopic splenectomy had an ITP. Mean operating time was 184 minutes. The mean spleen size was 11 cm and the mean weight was 186 g (70-450). No patient died or had complications. No patient required a conversion to an open surgery. Transfusions were not required. The median hospital stay was 3 days. CONCLUSIONS: Elective laparoscopic splenectomy is a safe and low risk surgical procedure.

Adolescent↗

PubMed1996

Splenectomy done during hematologic remission to prevent relapse in patients with thrombotic thrombocytopenic purpura.

OBJECTIVE: To assess whether splenectomy done during hematologic remission reduces the relapse rate in patients with relapsing thrombotic thrombocytopenic purpura. DESIGN: Consecutive case series. SETTING: Tertiary care teaching hospital. PATIENTS: 6 consecutive patients seen during a 10-year period who had had one or more relapses of thrombotic thrombocytopenic purpura. INTERVENTIONS: All patients had elective splenectomy while in hematologic remission and were followed after surgery for as long as 8.0 years. MEASUREMENTS: Attack rates (events per year) were calculated for each patient from time of presentation to time of splenectomy and from time of splenectomy to January 1996. RESULTS: A total of 26 episodes of thrombotic thrombocytopenic purpura occurred over 22.3 patient-years before splenectomy. After splenectomy, 3 acute episodes occurred over 22.7 patient-years. The attack rate (+/-1 SD) decreased from 2.3 +/- 2.0 events per year to 0.1 +/- 0.1 events per year. CONCLUSION: In patients who have had one or more relapses of thrombotic thrombocytopenic purpura, splenectomy done during hematologic remission reduces the frequency of acute relapse and the resulting need for medical therapy.

Humans↗

PubMed1978

Splenectomy in chronic myeloid leukemia.

We review splenectomy in chronic myeloid leukemia, emphasizing recent studies that have evaluated early splenectomy during the chronic phase of the disease. Despite current interest in splenectomy in chronic myeloid leukemia, uncontrolled clinical trials to date suggest that the operation during the early phase neither delays the onset of blastic transformation nor prolongs survival. Immediate operative mortality of splenectomy during the chronic phase is low, generally less than 1%. The morbidity of the procedure, however, remains formidable due to infectious and thromboembolic complications. Splenectomy during chronic-phase chronic myeloid leukemia permits easier control of the disease in patients who are thrombocytopenic due to busulfan toxicity or sensitivity. Splenectomy during the chronic phase may also palliate those patients who suffer from acute splenic events or massive splenomegaly. Splenectomy in blast-phase disease should be considered a heroic measure providing little benefit to most patients.

Aged↗

PubMed1999

[The role of computed tomography in assessing subphrenic abscesses after posttraumatic splenectomy].

INTRODUCTION: We studied subphrenic inflammatory abscesses and splenic fluid collections after splenectomy for trauma. These complications may appear early or late postoperatively; they are easily demonstrated with CT, which permits accurate spatial assessment of the lesions and appropriate treatment with percutaneous drainage. We investigated the diagnostic accuracy of CT in subphrenic inflammatory conditions after emergency splenectomy for traumatic spleen rupture and found that CT is a precious tool for rapid and easy diagnosis and follow-up of subphrenic abscesses treated with percutaneous drainage. MATERIAL AND METHODS: Thirteen patients with left subphrenic inflammatory abscesses after splenectomy for trauma were examined from 1994 to 1998. They were 9 men and 4 women ranging in age 16-67 years (mean: 32). CT demonstrated abscesses early postoperatively in 9 patients and late postoperatively (mean: 3 months) in 4 patients. Abscesses were diagnosed with CT on admission for an abdominal emergency in 3 cases; one abscess was found at outpatient US performed for persisting left abdominal pain. CT-guided percutaneous drainage was performed in all patients with the Trocar technique. RESULTS: A large inflammatory liquid collection with the typical "liquid pseudospleen" appearance and characterized by tomodensitometric coefficients of corpusculated fluid was seen in 3 cases. Multiple confluent lesions with septa were found in 3 cases. Contrastography of the abscess cavity with the injection of a water-soluble iodinated contrast agent was performed in 2 cases to detect fistulas connecting to the intestinal loops. Subphrenic abscesses had the same CT patterns both early and late postoperatively, with the collection organizing into thick and corpusculated phlogistic material and exhibiting enhanced capsulofibrous differentiation. Air bubbles and water-air levels within the collection were found in 7 cases and considered a pathognomonic sign of inflammatory abscesses. A periabscessual reaction involving intestinal loops and adjacent organs was seen in 4 cases. DISCUSSION AND CONCLUSIONS: Splenectomy causes depressed phagocytosis and decreases serum levels of IgM and antigen response. This calls for careful selection of the patients absolutely requiring splenectomy, such as those with decompensated circulation and multiple parenchymal ruptures or spleen detachment from its stalk. Subphrenic abscesses after splenectomy account for 2.5% of postoperative complications and those after splenectomy for trauma are rarer still, with 1.3%. CT is the imaging method of choice in detecting inflammatory abscesses in the residual splenic cavity and assessing their extent. CT-guided drainage is the first-line treatment, while surgery is reserved to later stages, when drainage fails or other complications occur. Finally, CT permits accurate positioning of the catheter inserted with the Trocar technique and its immediate monitoring, which permits to assess treatment efficacy.

Adolescent↗

PubMedDate not supplied

[Splenectomy in immune thrombocytopenia and other hematological diseases].

The Authors report a retrospective study of 74 splenectomies performed for hematologic diseases. The role of splenectomy has changed over recent years with increased indications for immune thrombocytopenic purpura (ITP). The aim of this study was to assess indications to surgery in relation to clinical presentation with typical hemorrhagic features or severe thrombocytopenia only; interval between onset of symptoms and splenectomy; failure of medical management and complications from steroid administration; scintigraphic studies predictive of response to splenectomy and preoperative treatment in patients with severe thrombocytopenia were also studied. The Authors reported response rates to splenectomy of 84% without mortality and only 11% of postoperative complications. These results encouraged to surgery for treatment of those patients with severe thrombocytopenia, who fail to obtain remission or develop serious complications after medical therapy. The splenectomy cured severe thrombocytopenia also in some patients with acquired immunodeficiency (HIV+). Moreover the Authors discuss the indications in patients with chronic lymphatic leukaemia and lymphoma diseases. In selected patients the splenectomy has the potential to relieve symptoms due to splenomegaly, correct cytopenias, specify hystological diagnosis and modify the disease course of malignant lymphomas. In fact splenomegaly sometimes complicated the course of malignant lymphomas because of hematologic abnormalities that are inconsistent with active chemotherapy.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Differential effects of radical D2-lymphadenectomy and splenectomy in surgically treated gastric cancer patients.

BACKGROUND/AIMS: Radical surgery with extended lymph node dissection (D2-LA) is the treatment of choice for gastric cancer patients in Japan. In Western countries results after D2-LA are controversially discussed, as increased D2-LA related complications are reported. The aim of this retrospective study was to analyze the influence of D2-LA and/or splenectomy on the clinical course, morbidity and long-term survival of gastric cancer patients. METHODOLOGY: Included in this series are 243 consecutively treated gastric cancer patients with a median age of 63.8 years. RESULTS: Though 56% of the patients presented with stage III and IV tumors, a resection rate of 95.5% with R0-resections in 73.7% was achieved. D2-LA rate was 66.3% with simultaneous splenectomy in 48.7%. Global morbidity was 41.6%. Surgical morbidity, leakage and abscess rates after curative R0 resections were not influenced by D2-LA (22.5/6.5/6.5% vs. 21.9/9.1/3.0% +/- LA) but by splenectomy (31.6/13.2/11.8% vs. 14.7/2.1/1% +/- Sx). Simultaneous splenectomy was associated with 7 of 9 leakages, 7 of 9 abscesses, and 4 of 5 cases with postoperative pancreatitis. Long-term survival (Kaplan-Meier) was 40.6% for all, and 58.1% for R0 resected patients. It was not influenced by splenectomy (56/60.3% +/- Sx). CONCLUSIONS: Radical D2-LA has no impact on the morbidity of gastric cancer patients, but splenectomy is always linked with elevated complications without improving survival rates. Therefore splenectomy as potential part of D2-LA can only be advocated in patients with direct infiltration of pancreas or spleen, in stage IV or whenever metastatic spread is supposed in the nodes along splenic artery or hilum.

Adolescent↗