D-2 resection with spleen and distal pancreas preserved for gastric cancer treatment with nil peroperative complications

BACKGROUND 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 1015 (530 males, 485 females; median age: 63±24 years) consecutive patients with histology-proven gastric cancer was submitted to gastrectomy and extended D-2 lymphadenectomy for treatment of their disease during a 19-year period (1994-2015) at the European Institute of Oncology in Milano, 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 stay were recorded. RESULTS Five hundred and sixty-nine total gastyrectomy, and 446 subtotal, were performed. Patients underwent total gastrectomy and 446 a subtotal distal one; splenectomy was performed in 16 cases and spleno-pancreatectomy in 24. The postoperative morbidity rate was 15%, the mortality rate was 1.4%. The median length of stay was 11.1 days. CONCLUSIONS These results compete favourably with those reported after D-1 gastrectomy in other series. D-2 gastrectomy with spleen and distal pancreas routine preservation can be considered a safe treatment of this disease with no significative complications.