Splenectomy is often performed in patients who undergo total
gastrectomy for
cancer of the upper stomach. Although
splenectomy facilitates
lymph node dissection of the splenic hilum and recent reports advocate spleen preservation, the role of the spleen is not fully elucidated in
gastric cancer treatment. This prospective randomized study was performed to evaluate the role of the spleen in immunological function in
gastric cancer patients who underwent total
gastrectomy and received postoperative immunochemotherapy. Forty-five patients with
gastric cancer were randomly allocated to four groups: 1.
splenectomy without
immunotherapy (OK-432 administration), 2.
splenectomy with
immunotherapy, 3. spleen preservation without
immunotherapy, 4. spleen preservation with
immunotherapy. Postoperative immunological function of these patients was compared among the four groups. NK cell activity of the peripheral blood lymphocytes (PBL) in spleen-preserved patients who received
immunotherapy was significantly higher for 24 weeks after surgery than that of the splenectomized patients with and without
OK-432 administration.
IL-2 production of PBL in spleen-preserved patients with
immunotherapy was significantly higher between 4 and 24 weeks after surgery compared with that of the splenectomized patients without
immunotherapy. The results suggest that spleen preservation might be beneficial in patients with less advanced
gastric cancer who receive postoperative immunochemotherapy after total
gastrectomy.