Our Summary

The research paper is about whether removing the spleen (splenectomy) as a preventative measure is beneficial for patients with advanced stomach cancer in the upper third of the stomach. The researchers reviewed and analyzed 18 studies from medical databases. Some of these studies suggested that keeping the spleen in place during stomach cancer surgery could be beneficial, while others found no significant advantage to doing so. However, the analysis showed that removing the spleen may increase the risk of post-surgery complications, such as a pancreatic fistula and anastomotic leakage, without improving overall survival rates. So, the researchers concluded that routinely removing the spleen during such surgeries might not be the best idea. They also emphasized that more randomized controlled trials are needed to confirm these findings, especially for specific types of tumors.

FAQs

  1. Does removing the spleen during stomach cancer surgery improve overall survival rates?
  2. What are the risks associated with removing the spleen during stomach cancer surgery?
  3. Are there more randomized controlled trials needed to confirm the findings about the benefits and risks of splenectomy in stomach cancer surgery?

Doctor’s Tip

A doctor might advise a patient considering splenectomy for stomach cancer to discuss the potential risks and benefits with their healthcare team before making a decision. It is important to weigh the potential benefits of removing the spleen against the increased risk of complications post-surgery. Additionally, patients should ask about alternative treatment options and seek a second opinion if necessary. Ultimately, the decision should be based on individual factors and the best available evidence.

Suitable For

Patients who are typically recommended for splenectomy include those with conditions such as:

  1. Hemolytic anemia: In cases where the spleen is excessively destroying red blood cells, causing anemia.

  2. Idiopathic thrombocytopenic purpura (ITP): A condition where the immune system mistakenly attacks and destroys platelets, leading to low platelet counts and an increased risk of bleeding.

  3. Hereditary spherocytosis: A genetic disorder that causes red blood cells to be more fragile and spherical, leading to their destruction by the spleen.

  4. Thalassemia: A group of inherited blood disorders that affect the production of hemoglobin, leading to anemia.

  5. Hodgkin’s lymphoma: A type of cancer that affects the lymphatic system, including the spleen.

  6. Non-Hodgkin lymphoma: Another type of cancer that affects the lymphatic system and may involve the spleen.

  7. Gaucher disease: A genetic disorder that causes the accumulation of fatty substances in cells and organs, including the spleen.

  8. Splenic abscess: An infection of the spleen that may require surgical removal in some cases.

It is important to note that the decision to recommend a splenectomy for a patient is made on a case-by-case basis, taking into consideration the individual’s specific condition, medical history, and overall health status.

Timeline

Before splenectomy:

  • Patient is diagnosed with advanced stomach cancer in the upper third of the stomach
  • Patient and medical team discuss treatment options, including the possibility of splenectomy
  • Patient undergoes pre-operative evaluations and tests to assess fitness for surgery
  • Surgical team plans the procedure, including whether or not to remove the spleen
  • Patient undergoes splenectomy as part of the stomach cancer surgery

After splenectomy:

  • Patient is monitored closely for post-surgery complications, such as pancreatic fistula and anastomotic leakage
  • Patient may experience a longer recovery period due to the additional surgical procedure
  • Patient may need additional support and care to manage the effects of splenectomy, such as increased risk of infections
  • Patient undergoes follow-up appointments and tests to monitor for any potential long-term effects of splenectomy
  • Patient and medical team assess the overall impact of splenectomy on the treatment and prognosis of stomach cancer

What to Ask Your Doctor

  1. What are the potential benefits of removing the spleen as a preventative measure for advanced stomach cancer in the upper third of the stomach?

  2. What are the potential risks and complications associated with splenectomy in this context?

  3. Are there alternative treatment options that do not involve removing the spleen?

  4. How will removing the spleen affect my overall quality of life and long-term health outcomes?

  5. Are there specific types of stomach tumors for which splenectomy may be more beneficial or necessary?

  6. What is the current evidence or research supporting the decision to remove or retain the spleen during stomach cancer surgery?

  7. How will the decision to remove or retain the spleen impact my prognosis and survival rates?

  8. Are there any specific factors or considerations that may make me a better candidate for splenectomy in this situation?

  9. What is the recovery process like after undergoing a splenectomy for advanced stomach cancer?

  10. Are there any ongoing clinical trials or studies investigating the role of splenectomy in the treatment of stomach cancer that I should be aware of?

Reference

Authors: Kunisaki C, Sato S, Tsuchiya N, Watanabe J, Sato T, Takeda K, Kasahara K, Kosaka T, Akiyama H, Endo I, Misumi T. Journal: In Vivo. 2020 Nov-Dec;34(6):3115-3125. doi: 10.21873/invivo.12145. PMID: 33144415