Splenic hilar lymph node dissection has been the standard treatment for advanced proximal gastric cancer. Splenectomy is typically performed as part of this procedure. However, splenectomy has some disadvantages, such as increased risk of postoperative complications, especially pancreatic fistula. Moreover, patients who underwent splenectomy are vulnerable to potentially fatal infection caused by encapsulated bacteria. Furthermore, several studies have shown an association of splenectomy with cancer development and increased risk of thromboembolic events. Therefore, splenectomy should be avoided if it does not confer a distinct oncological advantage. Most studies that compared patients who underwent splenectomy and those who did not failed to demonstrate the efficacy of splenectomy. Based on the results of a randomized controlled trial conducted in Japan, prophylactic dissection with splenectomy is no longer recommended in patients with gastric cancer with no invasion of the greater curvature. However, patients with greater curvature invasion or those with remnant gastric cancer still need to undergo splenectomy to facilitate splenic hilar node dissection. Spleen-preserving splenic hilar node dissection is a new procedure that may help delink splenic hilar node dissection and splenectomy. In this review, we examine the evidence pertaining to the efficacy and disadvantages of splenectomy. We discuss the possibility of spleen-preserving surgery for prophylactic splenic hilar node dissection to overcome the disadvantages of splenectomy.

Objective:To explore the clinical characteristics, diagnosis and treatment of Petersen hernia after gastrectomy.Methods:The clinical data of 6 patients with Petersen hernia developed after gastrectomy in Shizuoka Cancer Center from Jan 2014 to Dec 2019 were retrospectively analyzed.Results:All 6 patients were males, with a median age of 76 years. The operative procedures for preceding gastrectomies were robotic-assisted total gastrectomy in 2 patients, laparoscopic distal gastrectomy in 2 patients, and laparoscopic proximal gastrectomy in 2 patients. Petersen′s defect was closed in all patients at previous gastrectomy. The time of onset was 1 month to 55 months after surgery. The main manifestations are acute pain in upper abdomen with nausea and vomiting. In all the cases, abdominal CT showed obstruction caused dilatation of the small intestine. The whirl sign was present in 3 patients. All the patients underwent reoperation with reduction and repair of the hernia. All the patients did not show obvious bowel necrosis. Their postoperative courses were uneventful, and all the patients were discharged. During the follow-up period, none of the patients developed complications related to the Petersen hernia.Conclusions:Petersen hernia is a rare complication of gastrectomy. It is important to conduct abdominal CT scanning as early as possible from the clinical history and physical findings, and to determine the surgical indication.