Lateral lymph node involvement presents another challenge in rectum cancer in the age of neoadjuvant chemoradiotherapy + total mesorectal excision: an evaluation of survival outcomes.

PURPOSE: In the last decades, total mesorectal excision (TME) and neoadjuvant chemoradiotherapy (nCRT) have produced an undeniable improvement in the treatment of rectal cancer. However, local recurrence is still an important problem, and the effect of lateral lymph node (LLN) involvement on local recurrence is a controversial issue. The aim of this study was to investigate the effects of LLN status on local recurrence and survival in rectal cancers treated with nCRT + TME. METHODS: Clinical features, pre- and post-nCRT lateral pelvic region imaging, long-term local recurrence, and the survival outcomes of 114 patients who underwent nCRT + TME for rectal cancer were evaluated. RESULTS: On MRI before nCRT, 20 (17.5%) patients had lateral lymph nodes (LLN+), and 94 (82.5%) patients had no lymph nodes in the lateral pelvic compartments (LLN-). Local recurrences at 1 year in LLN+ and LLN- patients were 3 (15.8%) and 2 (2.3%), respectively (p=0.039). Five-year local recurrence-free survival rates and the mean duration of recurrence-free survival in LLN+ and LLN- patients were 56.2%, 42.6 months, and 87.3% 66.9 months, respectively (p=0.001). Disease-free survival and overall survival were shorter in LLN+ patients, but the difference was not statistically significant (p=0.096 and p=0.46, respectively). In the multivariate analysis, LLN involvement was determined to be an independent risk factor for local recurrence-free survival (Hazard Ratio 4.54, p=0.003). CONCLUSION: Lateral lymph node involvement causes local recurrence to remain high after nCRT + TME. LLN status should be considered in treatment planning. Further studies are needed to define precise criteria for LLN involvement and the effect of LLND on local recurrence and survival.

Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients

Background/aim/AIM: This study aimed to evaluate the regression pattern with the distal intramural spread (DIS) of rectum cancer after preoperative chemoradiation. Materials and methods: Specimens from 56 patients who underwent radical resection after preoperative chemoradiation for rectal cancer were examined. The regression pattern (total, fragmented) of the tumor was recorded. DIS status was evaluated by creating sections 0.2 to 0.3 cm thick. Results: A single macroscopic residual area was detected in all specimens. In 10 patients (17.8 %), pathologically complete responses were identified, and DIS was detected in 33 patients (58.9%). The average DIS distance was 0.56± 0.3 cm (range 0.2 ­ 1.8 cm); the spread was < 1 cm in 87.9% of the patients (29/33). The overall survival rates for 5 and 7 years were 76.8% and 73.2%, respectively. The survival rates between patients with and without DIS were not statistically different (94.6± 5.5 vs. 75.1 ± 10.2 months, respectively). In all of the patients, tumor regression pattern was total shrinkage of the tumor. Conclusion: A sufficient distal resection margin for rectal cancer after preoperative chemoradiation is 1 cm in the vast majority of cases. However, DIS may exceed 1 cm in a small proportion of patients.

Unresectable pancreatic adenocarcinoma with complete clinical response following chemoradiotherapy.

Locally advanced or metastatic disease is present in 2/3s of patients with pancreatic cancer. Pancreatic cancer patients are assessed as resectable, potentially resectable (borderline) and unresectable according to pre-operative examinations. The chance for operability may be enhanced by using adjuvant-neoadjuvant systemic chemotherapy, radiotherapy or both. The rates of R0 resection may be increased by means of treatment delivered this way. This case report presents a pancreatic adenocarcinoma case that was assessed to be resectable but was identified to be unresectable during surgical exploration, thus received adjuvant chemoradiotherapy. The patient was then re-evaluated, identified as resectable and received pancreaticoduodenectomy.

Giant hemangiomas: effects of size and type of surgical procedure on postoperative outcome.

BACKGROUND/AIMS: Controversies still exist regarding the management of giant hemangiomas. The purpose of this study was to evaluate in a retrospective manner the effects of size and type of surgical procedures on early postoperative results. METHODOLOGY: Between January 2000 and January 2011, a total of 82 patients underwent surgery. Patients were divided into 2 groups; according to size (Group 1 >10cm and Group 2 ≤10cm) and the selected operative procedure. RESULTS: When the patients were compared according to size of the lesions, the operation time was significantly longer (p=0.01) and the amount of blood loss was significantly higher (p=0.04) in hemangiomas >10cm. If the patients were compared according to type of the surgical procedure, hepatic resection was more frequently preferred in bilobar and left lobe localized lesions, whereas enucleation was significantly more chosen in lesions localized to the right lobe (p=0.01). CONCLUSIONS: Size of the hemangioma did not alter selection of the surgical procedure in this series. Larger hemangiomas are associated with longer operation time and more blood loss. Surgical results after enucleation and resection are similar. Although enucleation seems preferable, it is not an easy procedure, and may result in severe bleeding.

The Effect of Age on Pancreaticoduodenectomy; Comorbidities, Short-term Outcomes, and Survival.

OBJECTIVE: To evaluate the complications, mortality, and survival rates of patients aged >70 years undergoing pancreaticoduodenectomy, and to determine associated risk factors. STUDY DESIGN: Descriptive study. Place and Duration of the Study: General Surgery Clinic of Eskisehir Osmangazi University Medical Faculty Hospital, Eskisehir, Turkiye, from January 2014 to September 2020. METHODOLOGY: A retrospective scrutiny of 94 patients who had undergone pancreaticodueodenectomy, was carried out. The patients were separated into two age groups of younger and older than 70 years, and were compared in respect of clinicopathological characteristics, comorbidities, perioperative characteristics, and complications. Independent risk factors for the endpoints of perioperative mortality and survival were investigated. RESULTS: No significant difference was determined between the groups in respect of biochemical values, and perioperative and histochemical characteristics. Comorbidities were present at a higher rate in the older patients (77.8% vs. 38.8%, p<0.001). The postoperative complication rates were similar (33.3% vs. 32.7%, p=0.944). Perioperative mortality (first 30 days) was determined at a significantly higher rate in the older age group (20.0% vs. 4.1%, p=0.016). The age of patients >70 years increased the risk of mortality 4.851-fold but was not an independent predictive factor (p=0.086). The groups were similar in respect of disease-free survival (DFS) and overall survival (OS, Log-rank p=0.780, p=0.386). Age [Hazard Ratio (HR): 1.029, p=0.048] and pancreas adenocarcinoma (HR: 1.846, p=0.028) were determined to be independent prognostic factors for DFS, and pancreas adenocarcinoma (HR 1.940, p=0.023) for OS. CONCLUSION: Older age was not seen to change survival in patients undergoing pancreaticoduodenectomy, but mortality within the first 30 days was affected. Age is not accepted as an absolute contraindication. It is recommended that pancreaticoduodenectomy is performed on patients aged >70 years with careful patient selection, prudent preoperative preparation, a meticulous surgical technique, and close multidisciplinary postoperative support. KEY WORDS: Pancreaticoduodenectomy, Elderly, Comorbidity, Complication, Mortality, Survival.

A prospective observational study of 468 patients undergoing D2 or D3 lymphadenectomy for gastric cancer.

BACKGROUND/AIMS: A single-center, prospective observational study was performed to evaluate outcomes in patients undergoing D2 or D3 lymphadenectomy for gastric cancer. METHODOLOGY: Lymphadenectomies were performed according to the classification published by the Japanese Gastric Cancer Association. RESULTS: Of 468 consecutive patients, 370 underwent D2 and 98 underwent D3 lymphadenectomy. Postoperative complications were significantly less common in the D2 group than in the D3 group (19.2% vs. 35.7%, p=0.001). Postoperative mortality in the two groups was similar, being 3.8% in the D2 group and 5.1% in the D3 group (p>0.05). Median postoperative survival times were also similar, in the D2 group being 37.8 months (95% CI: 23-52.5), and in the D3 group 30.2 months (95% CI: 13-47.3, p>0.05). CONCLUSIONS: In patients who underwent gastrectomy with curative intent, lymphadenectomy that was more extensive than D2 did not provide a survival benefit compared to D2 dissection.

Ethyl Pyruvate; from Liver Preservation Solutions University of Wisconsin (UW) Increases the Effectiveness of the Solution.

BACKGROUND: The most important factor affecting the success rate of liver transplants is the preservation of the normal histologic and biochemical properties of the cells in the tissue taken. The study aimed to identify the possible increase in efficacy of ethyl pyruvate, which has a hepatoprotective effect, on the University of Wisconsin (UW) solution. METHODS: Rats were randomly selected and divided into 4 groups. After a laparotomy, the small intestines were removed from the abdomen and the portal pedicle was identified. Arterial and venous circulation of the liver was interrupted. After the portal vein was cannulated (and the distal of the portal pedicle was ligated, the liver was perfused with a solution. Perfusion solution was selected as Ringer Lactate in Group 1. In group 2, UW solution was chosen as the perfusion solution. In Group 3, the perfusion solution was chosen as the UW solution, but ethyl pyruvate at a dose of 40 mg/kg was administered intraperitoneally to the experimental animals 30 minutes before hepatectomy. In Group 4, as a perfusion solution, a UW solution with 40 mg/kg dose of ethyl pyruvate added to it was used. RESULTS: With TUNEL and Caspase-3 staining, a significant decrease was found in the apoptosis rates of Groups 2, 3, and 4 at the 12th hour post hepatectomy when compared with Group 1. When the morphometric liver sinusoid/parenchyma ratios and vena centralis diameters of the groups were examined, it was found that all preservation solutions containing the UW solution were more protective than the RL solution. CONCLUSIONS: Ethyl pyruvate is regarded as a promising agent that can increase the effect of the UW solution on organ preservation solutions. Because this study is the first in literature to apply ethyl pyruvate in preservation solutions, additional studies with larger series and different doses are needed.

Effects of thyroid hormone supplementation on anastomotic healing after segmental colonic resection.

BACKGROUND: Alterations of thyroid hormones in colorectal surgery were previously studied. The aim of the present study was to determine the effects of triiodothyronine (T3) supplementation on anastomotic healing after segmental colectomy. MATERIAL AND METHODS: Thirty male Wistar albino rats were divided into sham (n = 6), control (n = 12), and experimental (n = 12) groups. Sham group rats were immediately sacrificed after segmental colonic resection. Control and experimental group rats underwent resection and anastomosis. Experimental group rats received a single dose of T3 (400 µg/100 g) in postoperative day 1. Half of both control and experimental group rats were sacrificed on postoperative d 3 and the remaining half were sacrificed on postoperative d 7. Hydroxiproline (HP), myeloperoxidase (MPO), thyroid stimulating hormone (TSH), free T3 (FT3), and free thyroxine (FT4) levels, bursting pressure, and histologic analyses of the anastomotic segments were compared. RESULTS: FT3 levels significantly decreased in control groups rats compared with the sham group (P < 0.01). However, T3 hormone given rats had no decline in FT3 levels. Anastomotic bursting pressure was significantly higher in the experimental group rats on postoperative d 7 (P = 0.015). Histopathologic analyses of the anastomotic segments determined significantly more severe edema and necrosis in control group rats (P < 0.05). Collagen deposition in the anastomotic tissue was significantly higher in experimental group rats on postoperative d 7 (P = 0.015). CONCLUSION: Anastomosis after colon resection is associated with decreased FT3 level. T3 supplementation ameliorates the reduction in FT3 and seems to provide constructive therapeutic effects on anastomotic healing.

Is serum placental growth factor a prognostic marker for stage III colorectal cancer patients?

BACKGROUND/AIMS: To evaluate the clinical usefulness of serum placental growth factor (sPIGF) levels in stage III colorectal adenocarcinomas (CRC). METHODOLOGY: Serum PIGF were measured in 70 healthy controls and in 80 stage III CRC patients. Also the association between preoperative sPGF levels, clinicopathological features and patients survival were evaluated in stage III CRC patients. RESULTS: sPIGF levels in stage III CRC patients were significantly higher than those in controls. There was no significant association between sPIGF levels and clinicopathological features and sPIGF is not a prognostic factor for survival. Multivariate regression analysis showed the sPIGF levels (hazard ratio=3.28; 95% CI=1.10-9.5, p=0.032) to be significant independent factors for local recurrence. CONCLUSIONS: Serum PIGF levels in stage III CRC patients are significantly higher compared with normal controls and may be an indicator of local recurrence in stage III CRC patients.

Presence of free cancer cells in the peritoneal cavity of patients who underwent curative gastrectomy with lymph node dissection.

BACKGROUND/AIMS: The aim of this study was to determine the ratio of patients with positive peritoneal cytology who underwent radical gastrectomy for gastric cancer, to evaluate the factors effecting risk of positive cytology and to analyze the effects cytology findings on survival. METHODOLOGY: Peritoneal lavage samples were obtained from 255 patients who underwent radical gastrectomy with D2 (184 patients) or D3 (71 patients) lymph node dissection between January 2000 and December 2007. RESULTS: Thirty-six (14.1%) of 255 patients had free cancer cells in the wash cytology samples. T stage (T4) and differentiation were found to be independent risk factors for positive peritoneal cytology in multivariate analysis. Survival rate of cytology negative patients was significantly higher, however cytology findings were not found to be an independent prognostic factor for survival. T stage, lymph node metastasis and Borrmann classification (Borrmann type 4) appeared to be independent prognostic factors for survival in multivariate analyses. CONCLUSIONS: Peritoneal cytology does not provide additional information according to the TNM (1997) staging system. However, it should be employed intraoperatively before potentially curable serosa involved gastric carcinomas, especially for T4 tumors. Surgery alone will not be enough for patients with positive cytology and further therapies should be employed.

Management of choledochal cysts in adults: a retrospective analysis of 23 patients.

BACKGROUND/AIMS: Choledochal cysts are rare congenital anomalies of the pancreaticobiliary system, whose etiology remains unknown. We aimed to review patients with choledochal cysts and to compare our results with current literature. METHODOLOGY: Twenty-three patients diagnosed as having choledochal cysts between January 2004 and July 2010 were evaluated retrospectively. RESULTS: Thirteen patients had type I (56.5%), 3 patients type II (13%), 3 patients type III (13%), 1 patient type IV-A (8.3%) and the remaining 3 patients had type V (13%) choledochal cysts. All patients with type I cysts underwent cyst excision with Roux-en-Y hepaticojejunostomy. Two patients with type II cysts underwent cyst excision with choledochoduodenostomy, whereas cyst excision with T-tube drainage was applied to the other. Endoscopic unroofing was performed type III cysts. The patient with type IV-A cyst was not eligible for surgery due to low cardiopulmonary performance status but ERCP was applied successfully more than 3 times for the extraction of the stones which fell from the intrahepatic ducts into the common bile duct. Patients with Type V cysts underwent left hepatectomy, choledocoduodenostomy and cadaveric liver transplantation, respectively. Wound infection developed in 5 patients and anastomotic leakage occurred in 3; one died from sepsis. CONCLUSIONS: Choledochal cysts are rare congenital malformations. Although treatment varies depending on the type of the cysts, complete excision of the cysts should be performed if possible.

Giant hemorrhagic adrenal pseudocyst in a primiparous pregnancy: report of a case.

Adrenal cysts are rare and are usually discovered incidentally during diagnostic imaging, surgery, or autopsy. Most cystic lesions of the adrenal gland are nonfunctioning and become symptomatic when complicated by rupture, hemorrhage, or infection. A 40-year-old woman presented with a history of gradual-onset pain in her left flank region at 20 weeks' gestation. Ultrasound showed a 20-cm cystic mass in her left abdominal cavity. Pertinent laboratory tests were within normal limits. The patient underwent exploratory laparotomy, which revealed a 20 × 15-cm left adrenal cyst; thus, we performed left adrenalectomy with complete excision of the cyst. Histological examination confirmed a hemorrhagic adrenal pseudocyst. The patient had an uneventful postoperative course, and subsequent routine obstetric ultrasound examinations showed normal fetal activity and development until the pregnancy terminated with a stillbirth caused by pre-eclampsia at 34 weeks' gestation. To the best of our knowledge, this is only the 12th reported case of adrenal pseudocyst discovered during pregnancy. We analyze the clinicopathologic findings and discuss the possible association of pregnancy, with special reference to etiopathogenesis, presentation, diagnosis, and treatment.

Postoperative hemorrhagic complications after elective laparoscopic cholecystectomy in patients receiving long-term anticoagulant therapy.

BACKGROUND AND AIMS: Among patients on long-term anticoagulant therapy who undergo laparoscopic cholecystectomy (LC), bleeding complications have not been extensively investigated. The objective of this study was therefore to investigate postoperative bleeding complications prospectively in patients on chronic oral anticoagulation. MATERIALS AND METHODS: In the period of January 2002 to December 2007, 44 patients on long-term anticoagulation with warfarin, an oral anticoagulant (OAC), underwent LC in our center. Oral anticoagulant was discontinued 5 days before the planned date of surgery, and patients were admitted to the hospital 3 days before. Upon admission, bridging anticoagulation with enoxaparin, a low molecular weight heparin (LMWH), was started. When their international normalized ratio (INR) decreased to <1.5, patients underwent LC. In the absence of postoperative bleeding complications, OAC and LMWH were resumed on the evening of the day of surgery, and LMWH was continued until each patient's target INR was reached. A comparison group was comprised by 1,421 consecutively enrolled patients with no comorbid disease who underwent LC during the same period. RESULTS: In the comparison group, postoperative bleeding was encountered in 21 patients (1.5%). In the anticoagulation group, postoperative bleeding was encountered in 11 patients (25%) and ranged from minor oozing from a port incision in one patient to hemorrhage, sepsis, and fatality in one patient. In the anticoagulation group, no significant differences were found between patients with and without postoperative bleeding in terms of age, gender, body mass index, American Society of Anesthesiologists score, INR, or other hemostasis parameters. CONCLUSIONS: In patients who underwent LC with bridging anticoagulation, postoperative bleeding was markedly more frequent than expected and was not predicted by the usual coagulation parameters. This suggests a need for methods that can indicate which patients on long-term anticoagulation are at risk for postoperative bleeding.

Surgical treatment for gastric cancer in Turkish patients over age 70: early postoperative results and risk factors for mortality.

PURPOSE: The aim of this study was to evaluate the effects of advanced age on early postoperative results and to investigate risk factors for mortality in Turkish gastric cancer patients. METHODS: From 2002 to 2007, 549 patients who underwent gastrectomy for gastric cancer were divided into two groups as patients younger than 70 years and patients aged 70 years or older. RESULTS: There were 387 patients in the younger group and 162 in the older group. Morbidity rates were similar (25.1% vs. 29.0%). Mortality was higher among the elderly patients (2.6% vs. 9.9%). Advanced age, albumin levels lower than 3 mg/dl, higher American Society of Anesthesiologists score, palliative resections and resection of two or more additional organs were independent risk factors for mortality. CONCLUSION: Age alone should not preclude gastric resection in elderly patients. However, for patients with multiple risk factors, more limited surgery should be considered.

Laparotomy with a curative intent in patients with suspected locally recurrent gastric cancer.

AIMS AND BACKGROUND: Most recurrent gastric tumors are unsuitable for further resection or palliative surgery. The aim of the present study was to evaluate the role of re-resection in patients with local-regional recurrences of gastric cancer. METHODS AND STUDY DESIGN: Between 1998 and 2007, 26 patients underwent laparotomy for local-regional gastric cancer recurrence. Length of time to recurrence, recurrence patterns, operative procedures, morbidity, mortality and survival after re-resection were evaluated. RESULTS: Re-resection was possible in 13 patients (50%). Among patients with resectable tumors, survival times were markedly longer, with 2 patients reaching 60 months of survival and 2 other patients reaching 48 and 28 months, respectively. Among patients with early recurrence, peritoneal carcinomatosis was more common. After re-resection, morbidity and mortality were seen, each in one patient. CONCLUSIONS: Most of the re-resected recurrences were intraluminal. In patients with early recurrences of gastric cancer, peritoneal carcinomatosis was encountered most frequently. Re-resection was beneficial and long-term survival was achieved after re-resection.

Results of positive proximal margin after resection for hilar cholangiocarcinoma: An analysis of 42 cases.

BACKGROUND/AIMS: Hilar cholangiocarcinoma (HC) is a tumor that invades the confluence of the left and right hepatic bile ducts. Surgery is the definitive treatment but is also technically demanding. Here, we report our experience on 42 patients who underwent surgical resection for HC. The aim of the present study was to evaluate the margin status of resected specimens on frozen sections and the impact of R1 resection margin on survival. MATERIALS AND METHODS: A total of 42 patients with HC who underwent surgical resection in our clinic between January 2008 and January 2017 were included in the study. Patients' charts were evaluated retrospectively. RESULTS: The 1-, 2-, and 4-year overall survival rates of the 42 patients were 76.2%, 40%, and 10.7%, respectively. The median survival rates of the patients with negative and positive proximal surgical margins were 22 (11.93-32.06) and 17 (14.43-19.56) months, respectively. There was no statistically significant difference between these two groups. CONCLUSION: In HC, surgery achieving negative proximal surgical margin is often very difficult. Our results demonstrate that frozen sections are reliable for the assessment of the invasion status of the proximal and distal ductal surgical margins. Although complete resection is potentially curative, survival of the patients with HC is still poor. If there is no distant metastasis at the time of diagnosis, then extirpating surgery should be encouraged as survival of the patients with positive and negative margins is not significantly different.

Endoscopic Treatment of the Coloanal Anastomotic Dehiscence and Stricture: Stenting Via Rendezvous Technique.

An anastomotic leak is a serious complication of colorectal surgery. Leak management is often grueling, and a definitive stoma is often mandatory for rescue therapy. Herein, we present a patient who experienced coloanal anastomotic dehiscence and complete stricture at the proximal part of the anastomosis. This case was successfully treated with a fully covered self-expandable metallic stent placement via the combined endoscopic (per ileostomy) and manual (per anal channel) rendezvous technique.

Mixed Adeno-Neuroendocrine Carcinoma; Case Series of Ten Patients with Review of the Literature

Aims: Mixed adeno-neuroendocrine carcinoma is a rare entity, diagnosed with immunohistochemical studies. Literature mainly includes case reports and series which are very few. In our study, we aimed to report a case series from a tertiary hospital with demographics of the patients, detailed tumor and clinical findings and follow-up plus survival conditions. Methods: Pathology database was explored for patients with the pathological diagnosis of 'mixed adeno-neuroendocrine carcinoma' and patients were identified retrospectively and evaluated in means of demographics, histopathological examination, tumor properties. Results: Ten patients had been diagnosed with mixed adeno-neuroendocrine carcinoma in our center, diagnosed at a mean age of 64.7. Stomach was found to be the most common localization. Five patients (50%) were diagnosed as grade 3. Following surgery, median follow-up was 15 months with a median survival time of 20.6 months. Conclusion: This case series may contribute to the literature on the pathological and clinical aspects of the mixed adenoneuroendocrine carcinoma of the gastrointestinal system.

Pancreatic stump closure using only stapler is associated with high postoperative fistula rate after minimal invasive surgery.

BACKGROUND/AIMS: Postoperative pancreatic fistula (POPF) is the most common cause of morbidity and mortality after distal pancreatectomy (DP). The aim of the present study is to determine the risk factors that can lead to POPF. MATERIALS AND METHODS: The study was conducted between January 2008 and December 2012. A total of 96 patients who underwent DP were retrospectively analyzed. RESULTS: Overall, 24 patients (25%) underwent laparoscopic distal pancreatectomy (LDP) and 72 patients (75%) open surgery. The overall morbidity rate was 51% (49/96). POPF (32/96, 33.3%) was the most common postoperative complication. Grade B fistula (18/32, 56.2%) was the most common fistula type according to the International Study Group on Pancreatic Fistula definition. POPF rate was significantly higher in the minimally invasive surgery group (50%, p=0.046). POPF rate was 58.6% (17/29) in patients whose pancreatic stump closure was performed with only stapler, whereas POPF rate was 3.6% (1/28) in the group where the stump was closed with stapler plus oversewing sutures. Both minimally invasive surgery (OR: 0.286, 95% CI: 0.106-0.776, p=0.014) and intraoperative blood transfusion (OR: 4.210, 95% CI: 1.155-15.354, p=0.029) were detected as independent risk factors for POPF in multi-variety analysis. CONCLUSION: LDP is associated with a higher risk of POPF when stump closure is performed with only staplers. Intraoperative blood transfusion is another risk factor for POPF. On the other hand, oversewing sutures to the stapler line reduces the risk of POPF.

Comparison of Early Postoperative Outcomes after Total Gastrectomy and D2 Lymph Node Dissection with and without Splenectomy.

BACKGROUND: A famous prognostic ingredient for gastric cancer is the lymph node metastasis. Previously in the therapy of gastric cancer, splenectomy was considered as a definitive part of lymph node dissection. Currently, preservation of the spleen is the accepted approach during total gastrectomy and routine splenectomy is abandoned. The aim of this study was to estimate the impression of splenectomy for D2 lymph node dissection with total gastrectomy. METHODOLOGY: Between February 1998 and January 2012, 1531 patients underwent gastric cancer surgery. Of these 257 patients, 205 patients underwent total gastrectomy with splenectomy, and the remaining 52 underwent a spleen-preserving total gastrectomy. RESULTS: No statistical difference between these two groups in terms of age, gender, comorbidity, stage and American Society of Anesthesiologists score, surgical complications were detected. A significant difference was not seen in these groups with regard to postoperative mortality too. CONCLUSION: Early postoperative results were similar after TG ± splenectomy. Performing splenectomy did not increase the postoperative morbidity and mortality.How to cite this article: Oter V, Dalgic T, Ozer I, Colakoglu K, Cayci M, Ulas M, Bostanci EB, Akoglu M. Comparison of Early Postoperative Outcomes after Total Gastrectomy and D2 Lymph Node Dissection with and without Splenectomy. Euroasian J Hepatogastroenterol, 2018;8(2):108-111.