Impact of Splenectomy on Long-term Outcomes after Gastrectomy for Gastric Cancer - a Population-based Study
Junttila, Anna; Helminen, Olli; Helmiö, Mika; Huhta, Heikki; Jalkanen, Aapo; Kallio, Raija; Koivukangas, Vesa; Kokkola, Arto; Laine, Simo; Lietzen, Elina; Louhimo, Johanna; Meriläinen, Sanna; Pohjanen, Vesa-Matti; Rantanen, Tuomo; Ristimäki, Ari; Räsänen, Jari V; Saarnio, Juha; Sihvo, Eero; Toikkanen, Vesa; Tyrväinen, Tuula; Valtola, Antti; Kauppila, Joonas H; on behalf of the FINEGO group (2024-10-10)
Springer
10.10.2024
Anna Junttila, Olli Helminen, Mika Helmiö, Heikki Huhta, Aapo Jalkanen, Raija Kallio, Vesa Koivukangas, Arto Kokkola, Simo Laine, Elina Lietzen, Johanna Louhimo, Sanna Meriläinen, Vesa-Matti Pohjanen, Tuomo Rantanen, Ari Ristimäki, Jari V. Räsänen, Juha Saarnio, Eero Sihvo, Vesa Toikkanen, Tuula Tyrväinen, Antti Valtola, Joonas H. Kauppila, Impact of splenectomy on long-term outcomes after gastrectomy for gastric cancer: a population-based study, Journal of Gastrointestinal Surgery, Volume 28, Issue 12, 2024, Pages 2090-2096, ISSN 1091-255X, https://doi.org/10.1016/j.gassur.2024.10.009
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© 2024 The Author(s). Published by Elsevier Inc. on behalf of Society for Surgery of the Alimentary Tract. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
https://creativecommons.org/licenses/by/4.0/
© 2024 The Author(s). Published by Elsevier Inc. on behalf of Society for Surgery of the Alimentary Tract. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
https://creativecommons.org/licenses/by/4.0/
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:oulu-202410246439
https://urn.fi/URN:NBN:fi:oulu-202410246439
Tiivistelmä
Abstract
Background:
No national studies comparing long-term survival after total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation exist. This study aimed to examine the 5-year overall survival (OS) of patients with gastric adenocarcinoma who underwent total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation in a population-based nationwide setting.
Methods:
This study included all patients undergoing total or partial gastrectomy with splenectomy or spleen preservation for gastric adenocarcinoma in Finland from 2005 to 2016, with follow-up until December 31, 2019. A total of 2196 patients with gastric cancer diagnosis and total or partial gastrectomy were identified in the registries. Of these patients, 2118 were applicable for this study. Cox proportional hazard models provided hazard ratios (HRs) with 95% CIs of 5-year OS. The results were adjusted for age, sex, year of operation, comorbidities, tumor location, pathologic stage, and neoadjuvant therapy.
Results:
The observed 5-year OS rates were 38.7% in patients with no or minor spleen injury, 39.7% in patients with splenectomy due to injury, and 30.8% in patients with splenectomy due to oncologic reasons (P = .032). Patients who underwent R0 gastrectomy with splenectomy due to oncologic reasons had higher 5-year mortality (the adjusted model HR, 1.26; 95% CI, 1.01–1.56) than patients who underwent spleen preservation.
Conclusion:
The OS was worst in patients who underwent gastrectomy with splenectomy due to oncologic reasons, highlighting the poor prognosis in patients with advanced gastric cancer. Splenectomy due to injury does not compromise the prognosis.
Background:
No national studies comparing long-term survival after total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation exist. This study aimed to examine the 5-year overall survival (OS) of patients with gastric adenocarcinoma who underwent total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation in a population-based nationwide setting.
Methods:
This study included all patients undergoing total or partial gastrectomy with splenectomy or spleen preservation for gastric adenocarcinoma in Finland from 2005 to 2016, with follow-up until December 31, 2019. A total of 2196 patients with gastric cancer diagnosis and total or partial gastrectomy were identified in the registries. Of these patients, 2118 were applicable for this study. Cox proportional hazard models provided hazard ratios (HRs) with 95% CIs of 5-year OS. The results were adjusted for age, sex, year of operation, comorbidities, tumor location, pathologic stage, and neoadjuvant therapy.
Results:
The observed 5-year OS rates were 38.7% in patients with no or minor spleen injury, 39.7% in patients with splenectomy due to injury, and 30.8% in patients with splenectomy due to oncologic reasons (P = .032). Patients who underwent R0 gastrectomy with splenectomy due to oncologic reasons had higher 5-year mortality (the adjusted model HR, 1.26; 95% CI, 1.01–1.56) than patients who underwent spleen preservation.
Conclusion:
The OS was worst in patients who underwent gastrectomy with splenectomy due to oncologic reasons, highlighting the poor prognosis in patients with advanced gastric cancer. Splenectomy due to injury does not compromise the prognosis.
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