Redefining the Role of Splenectomy in Scirrhous Gastric Cancer: Toward a Selective Multimodal Strategy

Scirrhous gastric cancer, characterized by diffuse infiltration and a high propensity for peritoneal dissemination, remains one of the most aggressive subtypes of gastric cancer. Despite a relatively high incidence of splenic hilar lymph node (No. 10) metastasis, the oncologic benefit of splenectomy remains controversial, while its association with increased postoperative morbidity is well established. Recent advances in systemic therapy, including immune checkpoint inhibitors and molecular-targeted agents, have shifted the treatment paradigm toward improved systemic disease control. In parallel, minimally invasive surgical approaches, particularly spleen-preserving splenic hilar lymph node dissection, have emerged as feasible alternatives to conventional splenectomy. However, in scirrhous gastric cancer, disease-specific features such as diffuse infiltration, marked fibrosis, and difficulty in intraoperative assessment continue to pose significant challenges. Furthermore, the optimal extent of lymphadenectomy, especially following neoadjuvant therapy, remains undefined. Taken together, splenectomy should no longer be regarded as a routine component of surgical management for scirrhous gastric cancer, but rather as a selective procedure tailored to individual tumor characteristics and treatment context. Future studies integrating systemic therapy, surgical safety, and oncologic adequacy are required to establish evidence-based strategies for this challenging disease.