Our Summary

The research paper discusses two different surgical methods for treating stomach cancer, known as D1 and D2. In Europe, two major clinical trials showed that D2 did not increase the overall survival rate of patients and even led to a higher death rate due to spleen removal. However, a follow-up study revealed that more people died from stomach cancer with D1 than D2. As a result, the standard surgery in Europe became D2 but without removing the spleen to avoid unnecessary deaths.

On the other hand, in Japan, the comparison of D2 and a modified version of D2 (which preserves the spleen) for a specific type of stomach cancer showed that the modified method was just as effective. This led to spleen-preserving D2 becoming the standard surgical method for these kinds of tumors in Japan.

However, the spleen is often removed for a thorough dissection of the lymph nodes near the spleen, which is a common site for cancer spread in certain types of stomach cancer. Recently, a new method has been developed which allows for the dissection of these lymph nodes without having to remove the spleen.

FAQs

  1. What were the results of the European phase III trials comparing D1 and D2 surgeries in relation to overall survival rates?
  2. How did the findings of the JCOG9501 and JCOG0110 phase III studies influence the standard surgery for gastric cancer in Japan?
  3. What is the relationship between splenectomy and metastasis in upper gastric tumors invading the greater curvature?

Doctor’s Tip

A doctor might tell a patient that while splenectomy may be necessary for complete dissection of certain lymph nodes during gastric cancer surgery, spleen-preserving surgery may be an option for some patients to prevent potential complications associated with splenectomy. It is important to discuss the risks and benefits of splenectomy with your doctor before making a decision.

Suitable For

Patients who are typically recommended for splenectomy are those with upper gastric cancer not invading the greater curvature, where complete dissection of the splenic-hilar nodes is necessary. Additionally, patients with tumors that have metastasized to the spleen or splenic hilum may also be recommended for splenectomy. It is important to consider the potential risks and benefits of splenectomy for each individual patient, taking into account factors such as overall health, tumor characteristics, and surgical expertise.

Timeline

Before splenectomy:

  1. Diagnosis of gastric cancer and evaluation for surgical treatment options.
  2. Discussion with a healthcare provider about the risks and benefits of splenectomy.
  3. Preoperative preparation and evaluation to ensure the patient is a suitable candidate for surgery.
  4. Surgical planning and decision-making regarding the extent of lymphadenectomy and the need for splenectomy.

After splenectomy:

  1. Recovery from the surgical procedure, including pain management and monitoring for complications.
  2. Follow-up appointments with healthcare providers to monitor healing and address any post-operative issues.
  3. Adjustment to life without a spleen, including potential changes in immune function and increased risk of certain infections.
  4. Long-term monitoring for potential complications related to splenectomy, such as thrombosis or sepsis.
  5. Regular follow-up appointments and surveillance for gastric cancer recurrence or metastasis.

What to Ask Your Doctor

  1. What are the risks and benefits of undergoing a splenectomy during gastric cancer surgery?
  2. How will a splenectomy affect my overall recovery time and post-operative care?
  3. Are there any alternative surgical approaches that can achieve the same outcomes without the need for splenectomy?
  4. What is the likelihood of complications or long-term side effects associated with splenectomy?
  5. How will splenectomy impact my immune system and overall health in the long term?
  6. What is the rationale for choosing to perform a splenectomy in my case, and are there any specific factors that make me a good candidate for this procedure?
  7. What is the surgeon’s experience and success rate with performing splenectomies in gastric cancer patients?
  8. Are there any specific precautions or lifestyle changes I should consider after undergoing a splenectomy?
  9. How will the removal of my spleen impact my risk of infection and ability to fight off illness in the future?
  10. What follow-up care or monitoring will be necessary after undergoing a splenectomy?

Reference

Authors: Faiz Z, Hayashi T, Yoshikawa T. Journal: Eur J Surg Oncol. 2021 Sep;47(9):2233-2236. doi: 10.1016/j.ejso.2021.04.019. Epub 2021 Apr 21. PMID: 33910779