Comparative Analysis and Options to Improve the Immediate and Long-Term Effects of Gastric Cancer Surgical Treatment

Introduction. Currently, there are absolute and relative indications for splenectomy in the surgical treatment of gastric cancer.
The aim of the study was to improve clinical outcomes of treatment in patients with gastric cancer identifying risks associated with splenectomy, and developing options to correct them.
Methods. The study included clinical findings and parameters of the quality of life of 380 patients with gastric cancer who were treated at the Voronezh Regional Clinical Oncological Hospital in 2013-2019. All patients were conventionally divided into 2 groups. The patients of the first group (study group, 172 people) underwent gastrectomy with D2 lymphadenectomy, including splenectomy. The patients of the second group (comparison group, 208 people) underwent spleen-preserving gastrectomy with dissection of lymph node groups 10 and 11. The average follow-up was 39.6 months. In the postoperative period, all patients were examined according to the Clinical Recommendations of the Russian Federation. The SF-36, GSRS questionnaires were used to assess quality of life.
Results. Splenectomy increased the incidence of early postoperative complications, including severe complications grades 3 - 5 according to the Clavien-Dindo classification, contributed to the development of reflux esophagitis and, in general, a worsen quality of life in the late postoperative period, but did not affect the patients’ survival.
Conclusion. The data obtained evidence a significantly worse and generally unfavorable safety profile of patients undergoing splenectomy compared to patients who underwent spleen-preserving gastrectomy. Reduced indications for splenectomy appear to be the option to solve this problem. Measures for correction of postoperative complications have been developed for patients with absolute indications for splenectomy.