Effectiveness and safety of splenectomy for gastric carcinoma:A meta-analysis  

作　　者：Kun Yang Xin-Zu Chen Jian-Kun Hu Bo Zhang Zhi-Xin Chen Jia-Ping Chen 

机构地区：[1]Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China

出　　处：《World Journal of Gastroenterology》2009年第42期5352-5359,共8页世界胃肠病学杂志（英文版）

基　　金：Supported by The Multi-disciplinary Treatment Project of Gastrointestinal Tumors,West China Hospital,Sichuan University,China;the National Natural Science Foundation of China (NSFC),No.30600591

摘　　要：AIM： To evaluate the impact of splenectomy on longterm survival, postoperative morbidity and mortality of patients with gastric cancer by performing a metaanalysis METHODS： A search of electronic databases to identify randomized controlled trials in The Cochrane Library trials register, Mediine, CBMdisc （Chinese Biomedical Database） and J-STAGE, etc was performed. Data was extracted from the studies by 2 independent reviewers. Outcome measures were survival, postoperative morbidity and mortality and operation-related events. The meta-analyses were performed by RevMan 4.3. RESULTS： Three studies comprising 466 patients were available for analysis, with 231 patients treated by gastrectomy plus splenectomy. Splenectomy could not increase the 5-year overall survival rate [RR = 1.17, 95% confidence interval （CI） 0.97-1.41]. The postoperative morbidity （RR = 1.76, 95% CI 0.82-3.80） or mortality （RR = 1.58, 95% CI 0.45-5.50） did not suggest any significant differences between the 2 groups. No significant differences were noted in terms of number of harvested lymph nodes, operation time, length of hospital stay and reoperation rate. Subgroup analyses showed splenectomy did not increase the survival rate for proximal and whole gastric cancer. No obvious differences were observed between the 2 groups when stratified by stage. Sensitivity analyses indicated no significant differences regarding the survival rates （P 〉 0.05）. CONCLUSION： Splenectomy did not show a beneficial effect on survival rates compared to splenic preservation. Routinely performing splenectomy should not be recommended.AIM:To evaluate the impact of splenectomy on longterm survival,postoperative morbidity and mortality of patients with gastric cancer by performing a metaanalysis.METHODS:A search of electronic databases to identify randomized controlled trials in The Cochrane Library trials register,Medline,CBMdisc(Chinese Biomedical Database) and J-STAGE,etc was performed.Data was extracted from the studies by 2 independent reviewers.Outcome measures were survival,postoperative morbidity and mortality and operation-related events.The meta-analyses were performed by RevMan 4.3.RESULTS:Three studies comprising 466 patients were available for analysis,with 231 patients treated by gastrectomy plus splenectomy.Splenectomy could not increase the 5-year overall survival rate [RR = 1.17,95% confidence interval(CI) 0.97-1.41].The postoperative morbidity(RR = 1.76,95% CI 0.82-3.80) or mortality(RR = 1.58,95% CI 0.45-5.50) did not suggest any significant differences between the 2 groups.No significant differences were noted in terms of number of harvested lymph nodes,operation time,length of hospital stay and reoperation rate.Subgroup analyses showed splenectomy did not increase the survival rate for proximal and whole gastric cancer.No obvious differences were observed between the 2 groups when stratified by stage.Sensitivity analyses indicated no significant differences regarding the survival rates(P > 0.05) .CONCLUSION:Splenectomy did not show a beneficial effect on survival rates compared to splenic preservation.Routinely performing splenectomy should not be recommended.

关 键 词：Gastric cancer SPLENECTOMY Survival rate MORBIDITY Operative surgical procedure Postoperative period Treatment outcome 

分 类 号：R735.2[医药卫生—肿瘤]