In Gastric Cancer Surgery, an extended radical operation is common procedure, and in cases of total gastrectomy, there is a tendency to perform splenectomy at the same time. However, regarding to the prophylactic splenectamy for clearing of spleen hilar nodes the prognostic ef- fectivity is controversiaL We studied the value of spleen preservation in total gastrectomy for gastric cancer by survival rate, according to tumor stage and tumor location and by inflammatory complications. And another study was done on cellular immunity of total gastrectomy patients by T-cell subset(T3T4T5 & T4T8 Ratio) and Natural Killer cell activity changes(preoperative day and postoperative 2 months) with or without combined splenectomy. In five year survival rate of stage I and II groups, spleen preserving group(78.7%) has better prognosis than splenectomized group(70.4%) and in stage III and IV groups, 5 year survival rate of nonsplenectomized cases(30%) showed higher than that of splenectomized cases(17%). Five year survival rate of nonsplenectomized, proximal gastric cancer group(57.5%) showed significantly better than that of splenectomized group(30%). Postoperative T4/T8, ratio and NK cell activity were markedly decreased compared to preoperative ratio in the splenectomized group than the non-splenectomized and control groups. Consequently spleen preserving group group had better prognosis than splenectomized group in total gastrectomy, which may be attributable in part to reduction of cellular immunity caused by splenectomy. It seems to be desirable that accordingly prophylactic splenectomy in gastric cancer surgery should be reconsidered.
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