Abstract:Objective:To investigate the effect of simultaneous splenectomy or non-removal of spleen on the survival of patients undergoing radical total gastrectomy for carcinoma of the middle and proximal stomach. Methods:The clinical data of 79 patients with proximal gastric cancer (located in proximal or middle stomach) who underwent radical total gastrectomy between 1994 and 2001 were investigated retrospectively. Of these 79 patients,17 patients (21.5％) underwent splenectomy and 62 patients (78.5％) did not. There were no significant differences in ages,sex,tumor size,tumor location,Borrmann type,histolgic type,histological differentiation, depth of invasion, lymph node metastasis,TNM staging, the number of resected lymph nodes,rate of lymph node metastasis, postoperative complications and recurrence rate between the two groups（P>0.05). Results:The median survival of patients with splenectomy and without splenectomy was (507.4±318.6) days and (849.4±672.9) days,respectively.The patients without splenectomy survived significantly longer than those with splenectomy（P=0.046）.The 1-year,3-year and 5-year survival rates of patients with splenectomy and without splenectomy were 61.18%, 8.23%, 0% and 81.56%, 48.28%, 30.62%, respectively. Multivariate Cox regression analysis indicated that only splenectomy was an independent prognostic factor (P=0.007). Conclusions:The rates of postoperative complications and tumors recurrence were not influenced by splenectomy. Splenectomy did not prolong the survival time of patients with proximal gastric carcinoma who underwent radical total gastrectomy. Preservation of the spleen can prolong postoperative survival time and improve the survival rate in these patients.Splenectomy might only be appropriate for patients with direct invasion of the spleen.