Beyond Lymph Nodes: Splenectomy, Bursectomy and Omentectomy

We will discuss here the role of splenectomy, bursectomy and omentectomy in the light of recent literature, taking as a starting point the indications reported by the most important guidelines: those from the Italian Research Group for Gastric Cancer (2015) and from the Japanese Gastric Cancer Association (2018). Splenectomy is indicated in cases of advanced gastric cancer with infiltration of the spleen or the pancreas. Despite the fact that 8–28% of proximal third gastric cancers metastasize to the splenic hilum nodes, the role of splenectomy as a facilitator of station 10 clearance is controversial and should be considered on condition that it can be conducted safely. Bursectomy is no longer supported as a technique increasing surgical cure rates. Still, it may have a role in selected patients candidate to non-standard multimodal management of stage IV gastric cancer. Omentectomy has always been part of curative gastrectomy in order to ensure control of micrometastases. However, the recent literature discusses this role and consensus regarding its real benefit seems lost.