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.

中文翻译：

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胃癌 10 号淋巴结完全清扫的缺点和保脾清扫的可能性：综述

脾门淋巴结清扫术已成为晚期胃癌的标准治疗方法。脾切除术通常作为该手术的一部分进行。然而，脾切除术有一些缺点，例如增加术后并发症的风险，尤其是胰瘘。此外，接受脾切除术的患者容易受到包囊细菌引起的潜在致命感染。此外，几项研究表明脾切除术与癌症发展和血栓栓塞事件风险增加有关。因此，如果脾切除术不能带来明显的肿瘤学优势，则应避免脾切除术。大多数比较接受脾切除术的患者和未未能证明脾切除术疗效的研究。根据在日本进行的一项随机对照试验的结果，不再推荐对未侵犯大弯的胃癌患者进行预防性脾切除术。然而，大弯受侵或残胃癌患者仍需行脾切除术以方便脾门淋巴结清扫术。保脾脾门淋巴结清扫术是一种新的手术，可能有助于将脾门淋巴结清扫术与脾切除术脱钩。在这篇综述中，我们检查了有关脾切除术疗效和缺点的证据。我们讨论了预防性脾门淋巴结清扫术的保脾手术的可能性，以克服脾切除术的缺点。对于没有侵犯大弯的胃癌患者，不再推荐预防性脾切除术。然而，大弯受侵或残胃癌患者仍需行脾切除术以方便脾门淋巴结清扫术。保脾脾门淋巴结清扫术是一种新的手术，可能有助于将脾门淋巴结清扫术与脾切除术脱钩。在这篇综述中，我们检查了有关脾切除术疗效和缺点的证据。我们讨论了预防性脾门淋巴结清扫术的保脾手术的可能性，以克服脾切除术的缺点。对于没有侵犯大弯的胃癌患者，不再推荐预防性脾切除术。然而，大弯受侵或残胃癌患者仍需行脾切除术以方便脾门淋巴结清扫术。保脾脾门淋巴结清扫术是一种新的手术，可能有助于将脾门淋巴结清扫术与脾切除术脱钩。在这篇综述中，我们检查了有关脾切除术疗效和缺点的证据。我们讨论了预防性脾门淋巴结清扫术的保脾手术的可能性，以克服脾切除术的缺点。大弯受侵或残胃癌患者仍需行脾切除术以利于脾门淋巴结清扫。保脾脾门淋巴结清扫术是一种新的手术，可能有助于将脾门淋巴结清扫术与脾切除术脱钩。在这篇综述中，我们检查了有关脾切除术疗效和缺点的证据。我们讨论了预防性脾门淋巴结清扫术的保脾手术的可能性，以克服脾切除术的缺点。大弯受侵或残胃癌患者仍需行脾切除术以利于脾门淋巴结清扫。保脾脾门淋巴结清扫术是一种新的手术，可能有助于将脾门淋巴结清扫术与脾切除术脱钩。在这篇综述中，我们检查了有关脾切除术疗效和缺点的证据。我们讨论了预防性脾门淋巴结清扫术的保脾手术的可能性，以克服脾切除术的缺点。