Comparative Outcomes of Spleen Preservation and Splenectomy in Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis.

IF 1.6 Q4 ONCOLOGY

Journal of Gastrointestinal Cancer Pub Date : 2025-10-15 DOI:10.1007/s12029-025-01334-5

Ana Luíza Rocha Soares Menegat, Brenda Luana Rocha Soares Menegat, Bárbara Corrêa Garcia Simões, Gustavo Tadeu Freitas Uchôa Matheus, Clara Rocha Dantas, Barbara Antonia Dups Talah, Francisco Cezar Aquino de Moraes

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引用次数: 0

Abstract

Objective: This systematic review and meta-analysis evaluated whether spleen-preserving surgery with gastrectomy reduces the risk of intra-and postoperative complications compared with splenectomy in patients with proximal gastric cancer.

Background: Total gastrectomy with splenic hilar lymph node dissection, often involving splenectomy, is the standard approach for proximal gastric cancer. However, the effect of splenectomy on patient outcomes remains unclear.

Methods: We searched PubMed, Scopus, Cochrane, and Web of Science databases for studies comparing spleen preservation and splenectomy in total gastrectomy. Randomized clinical trials (RCTs) and observational studies were included in this study. Risk Ratios (RR) and Mean Differences (MD) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I² test, and statistical significance was set at p < 0.05.

Results: Ten studies with 2 221 patients were included, 1 RCT and 9 retrospective cohort studies. Of these, 1 173 (52.81%) underwent spleen-preserving surgery, and 1 048 (47.19%) underwent splenectomy. Spleen-preserving surgery was associated with reduced pancreatic fistula (RR 0.30; p < 0.000001), blood loss (MD -172.47; p = 0.012396), anastomotic leak (RR 0.51; p = 0.006769), intra-abdominal abscess (RR 0.40; p = 0.000160), and complications according to the Clavien-Dindo classification (RR 0.50; p = 0.010315). Other outcomes, such as the length of hospital stay, operative time, pulmonary complications, and wound infection showed no significant differences.

Conclusion: Spleen-preserving gastrectomy reduces postoperative complications compared with splenectomy, supporting its use as the safer approach in proximal gastric cancer whenever oncologic safety is ensured.

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近端胃癌全胃切除术中脾保留与脾切除的比较结果：一项系统综述和荟萃分析。

目的：本系统综述和荟萃分析评估与脾切除术相比，保脾手术加胃切除术是否能降低近端胃癌患者的术后并发症风险。背景：全胃切除术合并脾门淋巴结清扫，通常包括脾切除术，是治疗近端胃癌的标准入路。然而，脾切除术对患者预后的影响尚不清楚。方法：我们检索PubMed， Scopus， Cochrane和Web of Science数据库，以比较全胃切除术中脾脏保留和脾切除的研究。本研究纳入随机临床试验（RCTs）和观察性研究。计算95%置信区间（CI）的风险比（RR）和平均差异（MD）。结果：纳入10项研究，共2221例患者，1项RCT研究，9项回顾性队列研究。其中1173例（52.81%）行保脾手术，1048例（47.19%）行脾切除术。保脾手术与胰瘘减少相关（RR 0.30; p）结论：与脾切除术相比，保脾胃切除术可减少术后并发症，在保证肿瘤安全的情况下，保脾胃切除术是更安全的胃癌近端切除方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Cancer ONCOLOGY-

CiteScore

3.80

自引率

0.00%

发文量

121

期刊介绍： The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.