Impact of splenectomy on surgical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction

Prognostic Impact of Splenectomy in Patients with Esophagogastric Junction Carcinoma

BACKGROUND/AIM

We evaluated the survival benefit of splenectomy in patients with esophagogastric junction (ECJ) carcinoma.

PATIENTS AND METHODS

We retrospectively examined clinicopathological and survival data for 60 surgically-treated patients with ECJ carcinoma.

RESULTS

The 5-year overall survival (OS) rate was 47%. Splenectomy was performed in 20 patients (30%). Multivariate Cox regression analysis revealed splenectomy (odds ratio (OR), 2.70; 95% confidence interval (CI)=1.06-7.17; p=0.04) and venous invasion (OR=3.03; 95%CI=1.20-9.27; p=0.02) as significant independent predictors of poorer OS. Splenic hilar lymph node metastasis was not observed. Multivariate logistic regression analysis identified perioperative blood transfusion (BTF) as a significant independent factor associated with splenectomy.

CONCLUSION

The survival benefit of splenectomy in ECJ carcinoma patients may decrease with increasing frequency of perioperative BTF for blood loss. We recommend that splenectomy should be performed carefully when indicated by the extent or invasion of EGJ carcinoma.

Results of postoperative radiochemotherapy of the patients with resectable gastroesophageal junction adenocarcinoma in Slovenia

Background.

Although the incidence of adenocarcinomas of the gastroesophageal junction (GEJ) is sharply rising in the Western world, there are still some disagreements about the staging and the treatment of this disease. The aim of this retrospective study was to analyse the effectiveness and safety of postoperative radiochemotherapy in patients with a GEJ adenocarcinoma treated at the Institute of Oncology Ljubljana.

Patients and methods.

Seventy patients with GEJ adenocarcinoma, who were treated with postoperative radiochemotherapy between January 2005 and June 2010, were included in the study. The treatment consisted of 6 cycles of chemotherapy with 5-FU and cisplatin and concomitant radiotherapy with the total dose of 45 Gy.

Results.

Twenty-six patients (37.1%) completed the treatment according to the protocol. The median follow-up time was 17.7 months (range: 3.3–64 months). Acute toxicity grade 3 or more, such as stomatitis, dysphagia, nausea or vomiting, and infection, occurred in 2.9%, 34.3%, 38.6% and 41.5% of patients, respectively. At 3 years locoregional control (LRC), disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS) were 78.2%, 25.3%, 35.8%, and 33.9%, respectively. In the multivariate analysis of survival, splenectomy and level of Ca 19-9 >20 kU/L before the adjuvant treatment were identified as independent prognostic factors for lower DFS, DSS and OS. Age <60 years, higher number of involved lymph nodes and advanced disease stage were identified as independent prognostic factors for lower DSS and OS.

Conclusions.

In patients with GEJ adenocarcinoma who first underwent surgery, postoperative radiochemotherapy is feasible, but we must be aware of a high risk of acute toxic side effects.

Influence of splenectomy on morbidity of esophageal cancer surgery

BACKGROUND AND AIM

During esophagectomy, splenic injury may occur due to unintentional operative trauma, caused by excessive traction on the splenic ligaments or misplacement of re-tractors. The role of spleen in immune system is well recognized and the addition of splenectomy to esophagectomy may increase the rate of complications. The goal of this study was to determine the influence of splenectomy on postoperative morbidity and mortality after esophageal resection for esophageal cancer.

MATERIALS AND METHODS

Between January 2001 and April 2006, 420 cases with esophageal cancer underwent esophagectomy in a referral cancer institute. In 14 patients (3.3%) splenectomy was added because of unwanted splenic injury during operation. In-hospital morbidities and mortality and hospital stay were compared between patients with and without concomitant splenectomy.

RESULTS

Although the overall complication rate in splenectomized patients was higher than other patients (43% vs. 30%), this figure was not statistically significant (P value: 0.3). Cervical anastomotic leakage occurred in 35.7% of splenectomized patients in comparison to 12.2% of control group (P value: 0.01, Odds Ratio: 3.93, CI95%: 1.27-12.2). There were no significant differences in cardiac and pulmonary complications, and in-hospital mortality rate between patients with and without splenectomy (P value > 0.05). Splenectomy did significantly affect post operative hospital stay (19 +/- 13 vs. 13 +/- 7 days, P value: 0.004).

CONCLUSIONS

During esophagectomy, unplanned splenectomy may increase the incidence of anastomotic leakage and hospital stay. Therefore, whenever possible preservation of the spleen should be considered. An unexpected relationship between splenectomy and anastomotic leaks needs further investigation.Key words: Esophageal cancer; esophagectomy; splenectomy; esophagus; leakage; morbidity; mortality; complication.