Prognostic significance of splenic hilar nodal involvement in proximal third gastric carcinoma.

Objective: The utility of prophylactic splenectomy in patients with proximal third gastric carcinoma is controversial. In this study, we investigated the significance of nodal involvement in the splenic hilum and the impact of splenectomy.

Methods: A total of 129 patients who underwent D2 radical resection with splenectomy for gastric carcinoma involving the upper portion of the stomach were analyzed.

Results: Lymph node metastasis at the splenic hilum was found in 21 (16.3%) of 129 cases. Multivariate analysis revealed that the number of metastatic lymph nodes was an independent risk factor for lymph node metastasis at the splenic hilum. The 5-year survival rate for patients with lymph node metastasis at the splenic hilum was 17.9%. There were significant differences in survival among patients grouped according to the extent of extraperigastric nodal involvement. While nodal involvement in the splenic hilum was found to be an independent prognostic factor, the number of metastatic lymph nodes was not.

Conclusions: The prognosis of patients with lymph node metastasis at the splenic hilum was significantly poorer compared to that for patients with metastases in the other extraperigastric nodes. Furthermore, prophylactic splenectomy appears not to improve survival of patients with proximal third gastric carcinoma.