https://www.youtube.com/watch?v=T5sNqOFwTfQ
The video highlights the lymphadenectomy along the splenic artery and the splenic hilum in a D2 total gastrectomy. Following the omento-bursectomy procedure,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8686201/
How the intervention might work. Adding splenectomy to total gastrectomy has oncological benefits because 9.8 to 27.9% of people with proximal gastric cancer have splenic hilar lymph node metastasis (Monig 2001; Zhu 2012), and complete dissection is not technically feasible without splenectomy ().The incidence of metastasis is higher in people with tumors involving the greater curvature than

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6992673/
Dr Kajitani reported good results of D2 gastrectomy even for advanced stages. 5 When performing a D2 total gastrectomy, splenectomy and distal pancreatectomy were routinely performed. 6 For some advanced tumors with lymphadenopathy involving the celiac trifurcation, en‐bloc resection of the stomach, the distal pancreas and spleen, as well as

https://www.jstage.jst.go.jp/article/jnms/88/3/88_JNMS.2021_88-315/_pdf
Total gastrectomy with splenectomy has long been per-formed in Japan as curative surgery for gastric cancer pa-tients with advanced lesions in the upper part of the stomach. However, the JCOG0110 trial found that non-splenectomy was noninferior to splenectomy23.Further-more, incidences of postoperative complications were

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873941/
Total gastrectomy with splenectomy vs Total gastrectomy without splenectomy. The follow-up was performed in a median period of 71.8 months. ... Consequently, the dissection of No.10 LNs was waived from the extent of D2 lymphadenectomy in total gastrectomy in the latest version of Japanese guideline (13, 24). We should note, however, only tumors

https://pubmed.ncbi.nlm.nih.gov/27280511/
Objective: To clarify the role of splenectomy in total gastrectomy for proximal gastric cancer. Backgrounds: Splenectomy in total gastrectomy is associated with increased operative morbidity and mortality, but its survival benefit is unclear. Previous randomized controlled trials were underpowered and inconclusive. Methods: We conducted a multiinstitutional randomized controlled trial.

https://www.jgca.jp/wp-content/uploads/2023/08/JGCA_Guidelines_ver3.pdf
Japanese gastric cancer treatment guidelines 2010 (ver. 3) Japanese Gastric Cancer Association ... splenectomy should be considered for tumors that are located ... Total gastrectomy 2.3.1.2 Distal gastrectomy D0: Lymphadenectomy less than D1 D1: Nos. 1, 3, 4sb, 4d, 5, 6, 7

https://meridian.allenpress.com/international-surgery/article/102/5-6/284/115349/Significance-of-Splenectomy-for-Upper-Gastric
In Japan, the role of splenectomy (Sp) in total gastrectomy (TG) for carcinoma of the proximal stomach has been discussed since the 1960s. From the 1970s to the 1980s, Sp was reported as a procedure to improve the prognosis. 1,2 However, its significance has not been clear since the 1990s. 3-5 The Japan Clinical Oncology Group (JCOG) conducted a phase III randomized clinical trial (JCOG 0110

https://onlinelibrary.wiley.com/doi/10.1002/ags3.12413
Total gastrectomy combined with splenectomy is performed for complete removal of the No. 10 LN and was historically a standard procedure in Japan. However, splenectomy is associated with several disadvantages for patients, such as increased postoperative morbidity, risk of thrombogenic disease, fatal infection from encapsulated bacteria, and

https://ascopubs.org/doi/10.1200/jco.2010.28.15_suppl.4020
4020 Background: In European gastrectomy trials, splenectomy was an important risk factor for operative morbidity/mortality associated with poor long-term survival. In Japan where splenectomy seldom causes mortality, 20-30% of proximal gastric carcinomas have nodal metastasis in the splenic hilum and its complete removal with splenectomy produces a cure in about 20% of them. Methods: We

https://onlinelibrary.wiley.com/doi/10.1155/2012/301530
The Japanese retrospective studies revealed that the frequency of LN metastasis to No. 10 in proximal gastric cancer was 15-20%, and the 5-year survival rate was 20-25% [2, 3]. Total gastrectomy with splenectomy is considered to be a standard procedure for proximal advanced gastric cancer in gastric cancer treatment guidelines .

https://ascopubs.org/doi/10.1200/JCO.2019.37.4_suppl.139
139 Background: In patients with locally advanced gastric cancer, total gastrectomy with splenectomy (TGS) is sometimes indicated when a tumor directly infiltrates the spleen or obvious splenic hilar lymph node metastasis exists. However, this procedure is technically demanding and can cause potentially fatal postoperative pancreas-related complications. TGS has increasingly been performed

https://europepmc.org/article/MED/12417603
Outcomes of laparoscopic versus open total gastrectomy with D2 lymphadenectomy for gastric cancer: a systematic review and meta-analysis. Yang Y , Chen Y , Hu Y , Feng Y , Mao Q , Xue W. Eur J Med Res, 27 (1):124, 18 Jul 2022. Cited by: 5 articles | PMID: 35844000 | PMCID: PMC9290297.

https://www.sciencedirect.com/science/article/pii/S0748798321004479
Although operative mortality has been reported to be low [18, 23] and splenectomy has been considered a part of standard D2 total gastrectomy [1], retrospective studies in Japan also failed to show a survival advantage for splenectomy over spleen preservation [24, 25].

https://www.semanticscholar.org/paper/Randomized-controlled-trial-to-evaluate-splenectomy-Sano-Yamamoto/d72146b5cf61daa085e43e9f4210d685674aab64
A randomized controlled trial has started in Japan to evaluate the role of splenectomy in the surgical management of gastric cancer and endpoints are overall survival, operative morbidity, operative time and blood loss. A randomized controlled trial has started in Japan to evaluate the role of splenectomy in the surgical management of gastric cancer. Patients with T2 or deeper carcinoma in the

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2787257
A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma.  Surgery . 2002;131(4):401-407. doi: 10.1067/msy.2002.121891  PubMed Google Scholar Crossref

https://www.kjco.org/journal/view.php?number=381
Among 285 patients, 208 patients (72.98%) had completion total gastrectomy without splenectomy (no splenectomy group) and 77 patients (27.02%) with splenectomy (splenectomy group). Before propensity score matching, two groups showed statistically significant differences in several parameters.

https://pubmed.ncbi.nlm.nih.gov/7676696/
Abstract. Surgery for gastric cancer in Japan has frequently been combined with resection of the spleen (splenectomy) or of the pancreatic body and tail and spleen (pancreatosplenectomy, PS). Splenectomy in patients with gastric cancer has been performed with two major purposes in mind: (1) curability of the cancer and (2) immunologic reasons.

https://pubmed.ncbi.nlm.nih.gov/4088225/
It has been well accepted that extensive prophylactic lymphadenectomy is certainly effective for elevating cure rate after gastric cancer surgery, however, regarding to the prophylactic splenectomy the arguments are controversial. We studied the value of splenectomy in total gastrectomy for gastric

https://bjssjournals.onlinelibrary.wiley.com/doi/abs/10.1002/bjs.5353
Preservation or removal of the spleen during total gastrectomy for proximal gastric cancer is a matter of debate. Methods: A randomized clinical trial included patients with gastric adenocarcinoma who underwent total gastrectomy either with (104 patients) or without (103) splenectomy.

https://pubmed.ncbi.nlm.nih.gov/37459840/
Introduction: Splenectomy for proximal gastric cancer was found to offer no survival benefit in a randomized trial clarifying the role of splenectomy (JCOG0110 study). Although many studies have explored risk factors for morbidities following total gastrectomy, none have assessed the risk factors for postoperative complications in spleen-preserving total gastrectomy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6803217/
In contract, the overall operative mortality rates in Japan from 2011 to 2012 were 2.3% after total gastrectomy and 1.07% after distal gastrectomy , and the equivalent 30-day mortality rates were 0.9% and 0.45% , respectively, which appeared to indicate better outcomes than in Western countries (36-38,40-42,45). However, there remains scope for

https://onlinelibrary.wiley.com/doi/abs/10.1007/BF00294715
Splenectomy in patients with gastric cancer has been performed with two major purposes in mind: (1) curability of the cancer and (2) immunologic reasons. Direct cancerous invasion to the pancreas requires PS, although examination of these cases revealed that in 34.3% of such macroscopic invasions only fibrous adhesion to pancreas existed.