Key messages
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In people with stomach cancer, there may be little to no difference in survival and the chance of the cancer coming back whether the spleen is removed or kept during surgery to remove the stomach. We are unsure about the effects of removing or keeping the spleen on death shortly after surgery.
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Removing the stomach and the spleen probably leads to more people having complications after the operation. However, we are very uncertain whether removing the spleen changes the chance of needing another operation, or the length of hospital stay. We found no evidence about quality of life.
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Future studies should investigate people with tumors in different locations and at different stages of severity. They should look at quality of life and unwanted effects.
What is stomach cancer?
Stomach cancer is a disease in which the cells forming the inner lining of the stomach become abnormal and start to divide uncontrollably, forming a mass called a tumor.
How is stomach cancer managed?
Stomach cancer in the upper third of the stomach is often treated by performing an operation to remove the stomach (total gastrectomy). Removing the spleen at the same time as the stomach also removes the lymph nodes near the spleen. The more lymph nodes that can be removed, the more accurately doctors can judge what stage a cancer has reached, which can indirectly improve survival by identifying people who can benefit from additional therapies. The routine surgical removal of the spleen during total gastrectomy is controversial: it may potentially benefit people in terms of survival; conversely, it is also possible that it may have no benefits and may be associated with unwanted effects.
What did we want to find out?
We wanted to find out if removing the spleen during surgery for stomach cancer is better or worse than leaving it in place. We looked at the effects on survival, chance of cancer coming back, death shortly after surgery, complications after surgery, need for another operation, length of hospital stay, and quality of life.
What did we do?
We searched for studies that compared removing the spleen versus keeping the spleen during total gastrectomy. Studies could take place anywhere, and be published at any time and in any language. We compared and summarized the results of the studies and rated our confidence in the evidence, based on factors such as study methods and study sizes.
What did we find?
We found five studies with 1002 adults undergoing surgery for stomach cancer. The studies were conducted in Asia and South America and were published between 1985 and 2017. On average, the proportion of women in the studies was between 20% and 30%. Four studies with 908 participants reported the tumor stage. Three studies with 736 participants reported the tumor depth and type. The studies reported the following outcomes: survival, chance of cancer coming back, death shortly after surgery, complications after surgery, need for another operation, and length of hospital stay.
Main results
Compared with keeping the spleen, removing the spleen during surgery for stomach cancer probably leads to more people having complications after surgery. It is unclear if removing the spleen has an effect on death shortly after surgery, the chance of needing another operation, or the length of hospital stay. Removing the spleen may make little to no difference to survival and the chance of cancer coming back. None of the studies reported quality of life.
What are the limitations of the evidence?
We are not confident in the evidence because it is possible that people in the studies were aware of what treatment they were getting, and not all the studies provided data about everything that we were interested in. In addition, some studies did not clearly report how they were conducted, and there are not enough studies to be certain about the results of our outcomes.
How up to date is this evidence?
The evidence is current to February 2025.
Lire le résumé complet
Objectifs
To evaluate the benefits and harms of splenectomy in participants undergoing total gastrectomy for gastric cancer.
Stratégie de recherche documentaire
We searched CENTRAL, MEDLINE, Embase and two trials registers, together with reference checking, and we contacted study authors to identify studies for inclusion in the review. The latest search date was 17 February 2025.
Conclusions des auteurs
For the comparison of splenectomy versus spleen preservation in adult participants undergoing total gastrectomy for gastric cancer, moderate-certainty evidence suggests that splenectomy probably increases the incidence of postoperative complications. The evidence is very uncertain whether splenectomy increases postoperative mortality, incidence of reoperation, or length of hospital stay. Low-certainty evidence suggests that splenectomy may result in little to no difference in overall survival and disease-free survival. More studies are necessary to evaluate the benefits and harms of splenectomy in which participants are stratified according to the tumor locations and clinical stages.
Financement
This Cochrane review was funded by the National Natural Science Foundation of China (Grant No. 81701950, 82172135), Natural Science Foundation of Chongqing (Grant No. CSTB2022NSCQ-MSX0058), Suitable Technology Promotion Project of Chongqing (Grant No. 2024jstg028), Joint Project of Pinnacle Disciplinary Group, and the Kuanren Talents Program of the Second Affiliated Hospital of Chongqing Medical University.
Enregistrement
Protocol (2021) DOI:10.1002/14651858.CD014601
