Splenic hilar
lymph node dissection has been the standard treatment for advanced proximal
gastric cancer.
Splenectomy is typically performed as part of this procedure. However,
splenectomy has some disadvantages, such as increased risk of postoperative complications, especially
pancreatic fistula. Moreover, patients who underwent
splenectomy are vulnerable to potentially fatal
infection caused by encapsulated bacteria. Furthermore, several studies have shown an association of
splenectomy with
cancer development and increased risk of thromboembolic events. Therefore,
splenectomy should be avoided if it does not confer a distinct oncological advantage. Most studies that compared patients who underwent
splenectomy and those who did not failed to demonstrate the efficacy of
splenectomy. Based on the results of a randomized controlled trial conducted in Japan, prophylactic dissection with
splenectomy is no longer recommended in patients with
gastric cancer with no invasion of the greater curvature. However, patients with greater curvature invasion or those with remnant gastric
cancer still need to undergo
splenectomy to facilitate splenic hilar node dissection. Spleen-preserving splenic hilar node dissection is a new procedure that may help delink splenic hilar node dissection and
splenectomy. In this review, we examine the evidence pertaining to the efficacy and disadvantages of
splenectomy. We discuss the possibility of spleen-preserving surgery for prophylactic splenic hilar node dissection to overcome the disadvantages of
splenectomy.