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Objective: Total gastrectomy for advanced gastric cancer is frequently combined with extended lymphadenectomy. This technique is easier when resection of distal pancreas and/or spleen is performed. We have tried to evaluate whether the resection of both structures and total gastrectomy in patients with advanced gastric cancer actually improve survival rates., Patients: From 1991 to 1999, 140 patients with advanced gastric cancer underwent total gastrectomy at the General Hospital of Albacete: 43 with simple total gastrectomy, 57 with total gastrectomy plus splenectomy and 40 with total gastrectomy plus distal pancreaticosplenectomy. Univariate and multivariate analysis were conducted in order to evaluate different prognostic factors and survival curves among the groups., Results: Survival rates of the three groups were compared for each factor, being only significant variables the degree of tumor infiltration in the gastric wall, the size of the tumor, the staging and the type of lymphatic infiltration. Neither splenectomy nor distal pancreaticosplenectomy improved the survival compared to simple total gastrectomy. Morbimortality rates increased with more aggressive surgical procedures, but differences were not significant., Conclusions: Resection of distal pancreas and/or spleen plus total gastrectomy for advanced gastric cancer is associated to a greater number of isolated lymph nodes, but do not improve the survival of patients.

A retrospective study of 43 patients who were operated on for portal hypertension was performed (29 distal splenorenal shunts, 7 total portosystemic shunts, five Sugiura's operations and 2 splenectomies with gastric devascularization). Eighteen patients had recurrence of hemorrhage, 10 had ascitis and six encephalopathy. Thirteen of the 43 patients (seven Warren's operations, five Sugiura's and one mesocaval shunt) received postoperative sclerotherapy. The overall operative mortality was 34.8%. In the period 1977-1982, six of 20 patients (30%) died, and in 1983-1988 nine of 23 died (39.1%) (p greater than 0.05); so, we concluded that we must improve the perioperative care and that this kind of operations must be performed only by experienced surgeons.

Present concepts of histiocytosis X are reviewed and the results obtained in three patients that underwent splenectomy are described; postoperative survival is analyzed in order to evaluate the possible beneficial influence of splenectomy. One case corresponded to a female with a survival of nine years and another one a male with a survival of fifteen months; both received postoperative treatment with corticosteroids and are asymptomatic at the present time. The third case had an unfavorable evolution (he did not receive postoperative treatment). Even though present experience dose not alow to establish definitive conclusions, we must consider in the usefulness of splenectomy as a part of the treatment of histiocytosis X.