Impact of D2 total gastrectomy including splenectomy for scirrhous gastric cancer in the era of effective adjuvant chemotherapy

Abstract

Abstract Background Total gastrectomy with D2 dissection including splenectomy (TGS) is usually selected for locally resectable scirrhous gastric cancer (SGC), which was established in the era of surgery alone. However, it remains unclear whether TGS for SGC is justified in the era of effective adjuvant chemotherapy. Methods This study included 120 SGC patients, consisting of 63 cases treated between January 2000 and December 2006 (Former group), and 57 cases treated between January 2007 and December 2016 (Latter group). We collected clinicopathological data, then examined survival and the therapeutic value index. Results The background characteristics were well-balanced, except for age and sex. The Latter group might be characterized by older population (P = 0.051) and frequent female (P = 0.067). Adjuvant chemotherapy was administered to 82.5% of the Latter group and was 15.9% in the Former group (P < 0.001). The 5-year overall survival rate of the Latter group was 57.9% (95% confidence interval: 43.2–70.0), seems better than that of the Former group (44.0%, 95% confidence interval: 31.5–55.8) (hazard ratio = 0.735, P = 0.221). Improvement of the index from the Former group was observed in the Latter group at almost all stations. The ratio of the index between these two groups was 1.38 at the D1 station and 1.60 at the D2 station. Index of splenic hilar node ranked similarly high in the both groups. Conclusion The therapeutic value index was improved in almost all nodal stations by S-1 adjuvant chemotherapy, especially in D2 nodes. TGS would be more important for locally resectable SGC in the era of effective adjuvant chemotherapy.