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

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.