Brief Article
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Nov 14, 2009; 15(42): 5352-5359
Published online Nov 14, 2009. doi: 10.3748/wjg.15.5352
Effectiveness and safety of splenectomy for gastric carcinoma: A meta-analysis
Kun Yang, Xin-Zu Chen, Jian-Kun Hu, Bo Zhang, Zhi-Xin Chen, Jia-Ping Chen
Kun Yang, Xin-Zu Chen, Jian-Kun Hu, Bo Zhang, Zhi-Xin Chen, Jia-Ping Chen, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
Author contributions: Hu JK and Yang K designed the research; Yang K, Chen XZ and Hu JK performed the research; Yang K and Chen XZ collected the data and wrote the paper; Zhang B performed a literature search and retrieved data; Chen ZX and Chen JP were consulted and analyzed the data.
Supported by The Multi-disciplinary Treatment Project of Gastrointestinal Tumors, West China Hospital, Sichuan University, China, and the National Natural Science Foundation of China (NSFC), No. 30600591
Correspondence to: Jian-Kun Hu, PhD, MD, Professor, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. hujkwch@126.com
Telephone: +86-28-85422878 Fax: +86-28-85164035
Received: August 6, 2009
Revised: October 10, 2009
Accepted: October 17, 2009
Published online: November 14, 2009
Abstract

AIM: To evaluate the impact of splenectomy on long-term survival, postoperative morbidity and mortality of patients with gastric cancer by performing a meta-analysis.

METHODS: A search of electronic databases to identify randomized controlled trials in The Cochrane Library trials register, Medline, CBMdisc (Chinese Biomedical Database) and J-STAGE, etc was performed. Data was extracted from the studies by 2 independent reviewers. Outcome measures were survival, postoperative morbidity and mortality and operation-related events. The meta-analyses were performed by RevMan 4.3.

RESULTS: Three studies comprising 466 patients were available for analysis, with 231 patients treated by gastrectomy plus splenectomy. Splenectomy could not increase the 5-year overall survival rate [RR = 1.17, 95% confidence interval (CI) 0.97-1.41]. The postoperative morbidity (RR = 1.76, 95% CI 0.82-3.80) or mortality (RR = 1.58, 95% CI 0.45-5.50) did not suggest any significant differences between the 2 groups. No significant differences were noted in terms of number of harvested lymph nodes, operation time, length of hospital stay and reoperation rate. Subgroup analyses showed splenectomy did not increase the survival rate for proximal and whole gastric cancer. No obvious differences were observed between the 2 groups when stratified by stage. Sensitivity analyses indicated no significant differences regarding the survival rates (P > 0.05).

CONCLUSION: Splenectomy did not show a beneficial effect on survival rates compared to splenic preservation. Routinely performing splenectomy should not be recommended.

Keywords: Gastric cancer; Splenectomy; Survival rate; Morbidity; Operative surgical procedure; Postoperative period; Treatment outcome