Brief Article
Copyright ©2009 The WJG Press and Baishideng.
World J Gastroenterol. Nov 14, 2009; 15(42): 5352-5359
Published online Nov 14, 2009. doi: 10.3748/wjg.15.5352
Table 1 The characteristics of the included randomized trials
StudyParticipantsInterventionsOutcomes
Csendes et al[63], 2002187 patients with gastric carcinoma entered this study. 97 patients with total gastrectomy and 90 patients with total gastrectomy and splenectomyTotal gastrectomy vs total gastrectomy plus splenectomy. The follow-up was at least 5 yearsFive-year overall survival and survival by stage. Postoperative morbidity and mortality. Kaplan-Meier survival curve. Duration of operation and hospital stay
Toge et al[6], 1985The patients underwent total gastrectomy and had the main location of the tumor on lesser curvature region. They were divided into 2 groups at random: 41 in splenectomy (+) and 38 in splenectomy (-) groupsSplenectomy vs splenic preservation. The follow-up was at least 5 yearsKaplan-Meier survival curve. 5-year overall survival were from reported percentages data
Yu et al[64], 2006A total of 216 patients with proximal gastric cancer were randomized. 103 patients had the spleen preserved and 104 had a splenectomySplenectomy vs splenic preservation. Of the 207 patients, 7 were lost to follow-up (follow-up rate 96.6%) and mean duration of follow-up was 5.4 yearsHarvested lymph nodes. Postoperative morbidity and mortality. Kaplan-Meier survival curve. 5-year overall survival were from reported percentages data
Table 2 The quality of the included randomized trials
StudyTruly randomConcealed allocationBaseline featuresEligibility criteriaBlinding assessmentLoss to follow-upIntention to treatStudy quality
Csendes et al[63], 2002YesUnclearYesYesUnclearYesNoFair
Toge et al[6], 1985UnclearUnclearNoNoUnclearUnclearUnclearPoor
Yu et al[64], 2006YesUnclearYesYesUnclearYesUnclearFair
Table 3 Outcomes of a meta-analysis of overall survival rates, safety, operation-related events and overall survival rates stratified by location of tumor
No. of studiesSplenectomy (n1/N)Splenic preservation (n1/N)RR/WMD (95% CI)P-value for effect sizeP-value for heterogeneityEffect model
Overall survival rate stratified by different length of follow-up
3122/231105/2351.17 (0.97, 1.41)0.10.85Fixed
Postoperative morbidity and mortality
Morbidity116/1049/1031.76 (0.82, 3.80)0.15NAFixed
Mortality26/1944/2001.58 (0.45, 5.50)0.470.82Fixed
Operation-related events
No. of harvested lymph nodes1104210320.00 (-6.06, 6.06)1NAFixed
Operation time (min)190297210.00 (-14.37, 34.37)0.42NAFixed
Length of hospital stay (d)19029723.20 (-1.60, 8.00)0.19NAFixed
Reoperation110/909/971.20 (0.51, 2.81)0.68NAFixed
Overall survival rate stratified by location of tumor (proximal and whole stomach)
293/19084/1971.14 (0.92, 1.41)0.230.91Fixed
Table 4 Sensitivity results of meta-analysis of overall survival rates and safety (excluding the trial with low quality)
No. of studiesSplenectomy (n1/N)Splenic preservation (n1/N)RR/WMD (95% CI)P-value for effect sizeP-value for heterogeneityEffect model
Overall survival rate stratified by different length of follow-up
293/19084/1971.14 (0.92, 1.41)0.230.91Fixed
Postoperative morbidity and mortality
Morbidity116/1049/1031.76 (0.82, 3.80)0.15NAFixed
Mortality26/1944/2001.58 (0.45, 5.50)0.470.82Fixed