Yusuf Çiçek

Effect of Simultaneous Splenectomy on the Survival of Patients Undergoing Curative Gastrectomy for Proximal Gastric Carcinoma

Abstract.Purpose: Splenectomy is sometimes performed simultaneously with curative gastrectomy for gastric carcinoma, especially when the tumor originates in the proximal one-third of the stomach or corpus, or when it invades the entire stomach, in an effort to remove metastatic lymph nodes at the splenic hilus and improve survival. However, splenectomy is not an innocent procedure and may cause increased morbidity and even mortality. Moreover, the long-term effect of splenectomy on survival is still controversial. The purpose of this study was to investigate the effect of simultaneous splenectomy on survival in patients with proximal tumors undergoing curative gastrectomy for gastric cancer. Methods: The effect of splenectomy on the 5-year survival of 61 patients with proximal gastric cancer (located in the cardia or the corpus) who underwent curative gastrectomy in our hospital between 1989 and 1993 was investigated retrospectively. Of these 61 patients, 38 (62.3%) underwent splenectomy and 23 (37.7%) did not. The relationship between the clinicohistopathological parameters and 5-year survival was retrospectively analyzed. Results: No significant differences were found in bivariate analysis between the survival of patients who underwent curative gastrectomy with and those who underwent curative gastrectomy without splenectomy (P = 0.984). Multivariate regression analysis indicated that only histological grade (P < 0.003) and lymph node metastasis (P < 0.001) were independent prognostic factors with or without splenectomy. Splenectomy itself was not an independent prognostic factor (P = 0.528). Conclusion: The findings of this retrospective study showed that simultaneous splenectomy had no effect on the survival of patients who underwent curative gastrectomy for gastric carcinoma. Thus, splenectomy may only be appropriate for patients with direct invasion of the spleen.

Late Results of Patients Undergoing Remedial Operations for Alkaline Reflux Gastritis Syndrome

Abstract Purpose: Many different remedial operations for alkaline reflux gastritis have been described. Analysis of their efficacy is difficult, because while many of the procedures have good early results, there are long-term failures due to their own complications. The aim of this study is to evaluate our experience with patients undergoing remedial operations for alkaline reflux gastritis syndrome. Material and methods: The clinical features and results of remedial operations of 65 patients with alkaline reflux gastritis syndrome were reviewed retrospectively. Data on the hospital course were collected by interviewing patients directly or by telephone contact. An assessment of each patient’s response to remedial operation was then made and a Visick score assigned. Results: All patients had been tried on a medical treatment and dietary restriction or both prior to remedial operation. Long-term follow up was possible in 46 patients. Seventy-six percent of patients who at the final state had a truncal vagotomy, distal gestrectomy and Roux-en-Y gastrojejunostomy have been found to show satisfactory results (Visick-I/Visick II). Three patients who had previously undergone a Roux-en-Y conversion later required re-operation for Roux-stasis syndrome and a near-total gastrectomy was performed on these patients. Other operations performed for alkaline reflux gastritis were converted to “uncut” Roux-en-Y in five patients and dismantling of gastrojejunostomy in two patients. Conclusions: For patients unresponsive to medical treatment, we reccommend the following strategy : a) for patients with truncal vagotomy plus gastrojejunostomy, dismantling of gastrojejunostomy should be the first choice b) for patients with prior Billroth-II gastrectomy, Roux-en-Y conversion is the most effective corrective operation, although it has its proper including Roux statis syndrome.