OBJECTIVETo investigate the effect of spleen preservation on the outcome of radical resection for cardia cancer.

METHODSData of 108 cardia cancer patients(Siewert types II and III ), undergone radical resection with D(2) or D(3) lymphadenectomy between July 1994 and December 2003 in our department, were analyzed retrospectively. Survival status was ascertained on December 2004. Of these 108 patients, 38 underwent splenectomy and 70 splenic preservation. Clinicopathological features and outcomes of the splenectomy and non-splenectomy groups were compared.

RESULTSSeventy-four patients (68.5%) had lymph node involvement; 18 patients (16.7%) had involvement of lymph nodes in the splenic hilus. Postoperative morbidity in two groups was similar. Overall 5-year survival rate in the non-splenectomy group was significantly higher than that of the splenectomy group (38.7% vs 16.9%, P=0.008). Multivariate regression analysis indicated that tumor invasion (P=0.009) and lymph node metastasis (P=0.001) were independent prognostic factors rather than splenectomy. Although splenectomy was associated with survival, it was not an independent prognostic factor (P= 0.085).

CONCLUSIONSSplenectomy does not improve survival of patients undergone curative resection for gastric cardia cancer. Thus, the spleen should be preserved in patients without direct cancer invasion of the spleen.