Is concomitant splenectomy necessary in radical gastric cancer surgery? A systematic review and meta-analysis

Purpose: This study is a systematic review and meta-analysis compare the short- and long-term outcomes of splenectomy (SP) versus splenic preservation (NSP) in radical gastric cancer surgery.

Methods: A comprehensive search of PubMed, Embase, Cochrane Library and Web of Knowledge was performed. Evaluation of short- and long-term outcomes was collected and analyzed by a fixed or random effects model, according to the heterogeneity using RevMan 5.2 software.

Results: A total of 5431 gastric cancer patients who underwent radical surgery (1706 with SP and 3725 with NSP) were reviewed in 11 studies included in this study. Compared with NSP, SP was significantly associated with higher rate of overall postoperative complication and increased incidence of pulmonary complications, abdominal abscess and pancreas complications. No statistical difference was observed regarding mortality, wound infection, anastomotic leakage and postoperative 5-year overall survival.

Conclusion: There was no difference in long-term oncological outcome but remarkably poorer short-term outcomes in SP group than NSP group. Therefore, SP seems unnecessary in radical gastric cancer surgery. However, well-designed, multicenter, prospective, randomized controlled trials are warranted for further validation.