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Current Oncology
Volume 26
Issue 2
10.3747/co.26.4391
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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
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Article

Impact of Spleen-Preserving Total Gastrectomy on Postoperative Infectious Complications and 5-Year Overall Survival: Systematic Review and Meta-Analysis of Contemporary Randomized Clinical Trials

by
A. Aiolfi
*,
E. Asti
,
S. Siboni
,
D. Bernardi
,
E. Rausa
,
G. Bonitta
and
L. Bonavina
Department of Biomedical Science for Health, University of Milan, Division of General Surgery IRCCS Policlinico San Donato, Milan, Italy
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2019, 26(2), 202-209; https://doi.org/10.3747/co.26.4391
Submission received: 7 January 2019 / Revised: 6 February 2019 / Accepted: 5 March 2019 / Published: 1 April 2019

Abstract

Background: The role of splenectomy in proximal gastric cancer is still debated. The objective of the present meta-analysis was to provide more-robust evidence about the effect of spleen-preserving total gastrectomy on postoperative infectious complications, overall morbidity, and 5-year overall survival (OS). Methods: PubMed, EMBASE, and the Web of Science were consulted. Pooled effect measures were calculated using an inverse-variance weighted or Mantel–Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I2 index and Cochran Q-test. Results: Three randomized controlled trials published between 2000 and 2018 were included. Overall, 451 patients (50.1%) underwent open total gastrectomy with spleen preservation and 448 (49.9%) underwent open total gastrectomy with splenectomy. The patients ranged in age from 24 to 78 years. No differences were found in the number of harvested lymph nodes (p = 0.317), the reoperation rate (p = 0.871), or hospital length of stay (p = 0.347). The estimated pooled risk ratios for infectious complications, overall morbidity, and mortality were 1.53 [95% confidence interval (CI): 1.09 to 2.14; p = 0.016], 1.51 (95% CI: 1.11 to 2.05; p = 0.008), and 1.23 (95% CI: 0.40 to 3.71; p = 0.719) respectively. The estimated pooled hazard ratio for 5-year OS was 1.06 (95% CI: 0.78 to 1.45; p = 0.707). Conclusions: Spleen-preserving total gastrectomy should be considered in patients with curable gastric cancer because it is significantly associated with decreased postoperative infectious complications and overall morbidity, with no difference in the 5-year OS. Those observations appear worthwhile for establishing better evidence-based treatment for gastric cancer.
Keywords: gastric cancer; splenectomy; spleen preservation; infectious complications; 5-year overall survival gastric cancer; splenectomy; spleen preservation; infectious complications; 5-year overall survival

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MDPI and ACS Style

Aiolfi, A.; Asti, E.; Siboni, S.; Bernardi, D.; Rausa, E.; Bonitta, G.; Bonavina, L. Impact of Spleen-Preserving Total Gastrectomy on Postoperative Infectious Complications and 5-Year Overall Survival: Systematic Review and Meta-Analysis of Contemporary Randomized Clinical Trials. Curr. Oncol. 2019, 26, 202-209. https://doi.org/10.3747/co.26.4391

AMA Style

Aiolfi A, Asti E, Siboni S, Bernardi D, Rausa E, Bonitta G, Bonavina L. Impact of Spleen-Preserving Total Gastrectomy on Postoperative Infectious Complications and 5-Year Overall Survival: Systematic Review and Meta-Analysis of Contemporary Randomized Clinical Trials. Current Oncology. 2019; 26(2):202-209. https://doi.org/10.3747/co.26.4391

Chicago/Turabian Style

Aiolfi, A., E. Asti, S. Siboni, D. Bernardi, E. Rausa, G. Bonitta, and L. Bonavina. 2019. "Impact of Spleen-Preserving Total Gastrectomy on Postoperative Infectious Complications and 5-Year Overall Survival: Systematic Review and Meta-Analysis of Contemporary Randomized Clinical Trials" Current Oncology 26, no. 2: 202-209. https://doi.org/10.3747/co.26.4391

APA Style

Aiolfi, A., Asti, E., Siboni, S., Bernardi, D., Rausa, E., Bonitta, G., & Bonavina, L. (2019). Impact of Spleen-Preserving Total Gastrectomy on Postoperative Infectious Complications and 5-Year Overall Survival: Systematic Review and Meta-Analysis of Contemporary Randomized Clinical Trials. Current Oncology, 26(2), 202-209. https://doi.org/10.3747/co.26.4391

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