Clinical Significance of Splenic Hilar Lymph Node Metastasis in Proximal Gastric Cancer

Prophylactic splenectomy for splenic hilar node removal is generally not advised because of the high morbidity and mortality rates and the uncertain impact on patient survival. The aim of this study was to compare the clinicopathologic characteristics and effect on survival of the following two groups: the splenic hilar lymph node metastasis group and the non-metastasis group. Three hundred and nineteen patients with proximal gastric adenocarcinoma who underwent curative total gastrectomy with simultaneous splenectomy and D2 lymph node dissection at the Samsung Medical Center between 1995 and 2004 were analyzed retrospectively. Forty one patients (12.9%) had splenic hilar node metastasis. The splenic hilar metastasis group was shown to have a higher proportion of females (48.8%), Borrmann type IV (34.1%), tumor size > 5 cm (82.9%), poorly differentiated adenocarcinoma (51.2%), signet ring cell carcinoma (31.7%), Lauren diffuse-type (80.5%), endolymphatic invasion (65.5%), and nerve invasion (46.4%; p < 0.05). There was no splenic hilar node metastasis in early gastric cancer. The 5-year survival rate was 11.04% for the hilar node metastasis group (p < 0.001), which was significantly lower than in the non-metastasis group, in which it was 51.57%. Multivariate analysis revealed that hilar node metastasis was an independent prognostic factor [hazard ratio 1.671; 95% confidence interval (CI) 1.075-2.595; p = 0.022]. Splenic hilar node metastasis was not apparent in early gastric cancer and had a very poor prognosis, even though curative resection was done, so the effectiveness of prophylactic splenectomy is uncertain.