Role of splenectomy in proximal gastric cancer patients undergoing total gastrectomy

The aim of the addition of splenectomy to a D2 gastrectomy in patients with gastric cancer is to achieve R0 resection and to improve patient survival. However, the survival benefit of splenectomy remains uncertain and the associated morbidity and mortality rates may compromise the beneficial effects of splenectomy (1,2). Given splenic hilar lymph node metastasis has not been observed in early gastric cancer (3), researchers have suggested that a splenectomy for the purpose of splenic hilar node clearance should be performed for patients with high suspicion of metastasis near the splenic hilum or direct tumor invasion of the spleen (3-6).