Results after D-2 resection with spleen and distal pancreas preserved for gastric cancer treatment

Background: purpose of this work was to verify the hypothesis that avoidance of routine splenectomy and distal pancreatectomy in a modified D-2 resection for gastric cancer can significantly lower the peroperative complications of this procedure in a population of Western patients. Patients and methods: a series of 915 (517 males, 398 females; median age: 62±23 years) consecutive patients with histology-proven gastric cancer underwent gastrectomy and extended D-2 lymphadenectomy for treatment of their disease during a 18-year period (1994-2012) at the European Institute of Oncology in Milan, Italy. Caudal pancreas and spleen were routinely preserved, unless the tumor was not closely adjacent to or directly invading these organs. Morbidity, overall per operative mortality, and length of hospital-staying were recorded. Results 559 total and 356 subtotal gastrectomies were performed. All of the 356 subtotal ones involved the distal stomach; splenectomy was performed in 14 cases and spleno-pancreatectomy in 21. The postoperative morbidity rate was 15%, the mortality rate was 1.4%. The median length of stay was 10.8 days. Conclusions: these results compete favourably with those reported after standard D-1 gastrectomy in Western series. D-2 gastrectomy with spleen and pancreas routine preservation can be considered a safe treatment of this disease.