Evidence map›Paper›PMID 27280511›Full record

Trial reportAnnals of surgery2017

Randomized Controlled Trial to Evaluate Splenectomy in Total Gastrectomy for Proximal Gastric Carcinoma.

Takeshi Sano, Mitsuru Sasako, Junki Mizusawa, Seiichiro Yamamoto, Hitoshi Katai, Takaki Yoshikawa, Atsushi Nashimoto, Seiji Ito, Masahide Kaji, Hiroshi Imamura and 3 more

2 registry-linked trialsAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Annals of surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 187 papers, 17 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
187citing papers in PubMed, 17 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05346874 phase2unknown statusnot on this mapstarted 2022, after this paper: background citation

Neoadjuvant Transcatheter Arterial Chemoinfusion and Embolism (TACiE) for Patients With Locally Advanced Adenocarcinoma of Stomach and Gastroesophageal Junction: a Prospective, Phase 2, Single Arm Trial.

TypeinterventionalSponsorShanghai Zhongshan HospitalRan2022 to 2025Enrolled37ConditionsGastric CancerArmsOxaliplatin, Teysuno, Transarterial chemoembolization (TACE)
NCT05396326 phase1unknown statusnot on this mapstarted 2022, after this paper: background citation

Neoadjuvant Transcatheter Arterial Chemoinfusion and Embolism (TACiE) for Patients With Locally Advanced Adenocarcinoma of Stomach and Gastroesophageal Junction: a Pilot Study

TypeinterventionalSponsorShanghai Zhongshan HospitalRan2022 to 2025Enrolled20ConditionsGastric CancerArmsOxaliplatin, Teysuno, Transarterial arterial chemoinfusion and embolism (TACiE)
3 · Its place in the literature

Who cites it

187 citing papers in PubMed, 17 syntheses or guidelines pooled it.

  1. Japanese gastric cancer treatment guidelines 2025 (7th edition).Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2026
    Guideline
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  4. Guideline
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  8. Establishing the Learning Curve of Laparoscopic and Robotic Distal Gastrectomy: a Systematic Review and Meta-Regression Analysis.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2023
    Pooled it
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  10. Evolution of treatment in gastric cancer- a systematic review.Journal of the Egyptian National Cancer Institute · 2022
    Pooled it
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  15. Guideline
  16. Japanese gastric cancer treatment guidelines 2014 (ver. 4).Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2017
    Guideline
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  18. Trial
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  20. Trial

127 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Takeshi Sano*Department of Surgery, Cancer Institute Hospital, Tokyo, Japan †Department of Surgery, Hyogo College of Medicine, Hyogo, Japan ‡Japan Clinical Oncology Group Data Center, National Cancer Center, Tokyo, Japan §Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan ¶Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan ||Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan **Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan ††Department of Surgery, Toyama Prefectural Central Hospital, Toyama City, Japan ‡‡Department of Surgery, Sakai City Medical Center, Sakai, Japan §§Department of Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan ¶¶Department of Surgery, Osaka National Hospital, Osaka, Japan.
Mitsuru Sasako
Junki Mizusawa
Seiichiro Yamamoto
Hitoshi Katai
Takaki Yoshikawa
Atsushi Nashimoto
Seiji Ito
Masahide Kaji
Hiroshi Imamura
Norimasa Fukushima
Kazumasa Fujitani
Stomach Cancer Study Group of the Japan Clinical Oncology Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo clarify the role of splenectomy in total gastrectomy for proximal gastric cancer. BACKGROUNDS: Splenectomy in total gastrectomy is associated with increased operative morbidity and mortality, but its survival benefit is unclear. Previous randomized controlled trials were underpowered and inconclusive.

methodsWe conducted a multiinstitutional randomized controlled trial. Proximal gastric adenocarcinoma of T2-4/N0-2/M0 not invading the greater curvature was eligible. During the operation, surgeons confirmed that R0 resection was possible with negative lavage cytology, and patients were randomly assigned to either splenectomy or spleen preservation. The primary endpoint was overall survival (OS) and the secondary endpoints were relapse-free survival, operative morbidity, operation time, and blood loss. The trial was designed to confirm noninferiority of spleen preservation to splenectomy in OS with a noninferiority margin of the hazard ratio as 1.21 and 1-sided alpha of 5%.

resultsBetween June 2002 and March 2009, 505 patients (254 splenectomy, 251 spleen preservation) were enrolled from 36 institutions. Splenectomy was associated with higher morbidity and larger blood loss, but the operation time was similar. The 5-year survivals were 75.1% and 76.4% in the splenectomy and spleen preservation groups, respectively. The hazard ratio was 0.88 (90.7%, confidence interval 0.67-1.16) (<1.21); thus, the noninferiority of spleen preservation was confirmed (P = 0.025).

conclusionsIn total gastrectomy for proximal gastric cancer that does not invade the greater curvature, splenectomy should be avoided as it increases operative morbidity without improving survival.

Indexed as

GastrectomySplenectomyAdenocarcinomaAdultAgedBlood Loss, SurgicalFemaleFollow-Up StudiesHumansMaleMiddle AgedOperative TimeStomach NeoplasmsSurvival AnalysisTreatment Outcome

Identifiers

PMID27280511

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.