{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T10:00:36Z","timestamp":1784973636249,"version":"3.55.0"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>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\u2010targeted agents, have shifted the treatment paradigm toward improved systemic disease control. In parallel, minimally invasive surgical approaches, particularly spleen\u2010preserving splenic hilar lymph node dissection, have emerged as feasible alternatives to conventional splenectomy. However, in scirrhous gastric cancer, disease\u2010specific 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\u2010based strategies for this challenging disease.<\/jats:p>","DOI":"10.1002\/ags3.70254","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T09:07:31Z","timestamp":1784970451000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Redefining the Role of Splenectomy in Scirrhous Gastric Cancer: Toward a Selective Multimodal Strategy"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9193-8269","authenticated-orcid":false,"given":"Tsutomu","family":"Hayashi","sequence":"first","affiliation":[{"name":"Department of Gastric Surgery National Cancer Center Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaki","family":"Yoshikawa","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery Yokohama City University  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"e_1_2_15_2_1","first-page":"371","article-title":"Borrmann's Type IV Gastric Cancer: Clinicopathologic Analysis","volume":"42","author":"Yokota T.","year":"1999","journal-title":"Canadian Journal of Surgery"},{"key":"e_1_2_15_3_1","doi-asserted-by":"crossref","first-page":"392","DOI":"10.5230\/jgc.2021.21.e37","article-title":"Limited Clinical Significance of Splenectomy and Splenic Hilar Lymph Node Dissection for Type 4 Gastric Cancer","volume":"21","author":"Kunitomo A.","year":"2021","journal-title":"Journal of Gastric Cancer"},{"key":"e_1_2_15_4_1","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1007\/s10120-020-01063-7","article-title":"Is Splenectomy for Dissecting Splenic Hilar Lymph Nodes Justified for Scirrhous Gastric Cancer?","volume":"23","author":"Hayashi T.","year":"2020","journal-title":"Gastric Cancer"},{"key":"e_1_2_15_5_1","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1007\/s10120-020-01136-7","article-title":"Gastrectomy With or Without Neoadjuvant S\u20101 Plus Cisplatin for Type 4 or Large Type 3 Gastric Cancer (JCOG0501): An Open\u2010Label, Phase 3 Randomized Trial","volume":"24","author":"Iwasaki Y.","year":"2021","journal-title":"Gastric Cancer"},{"key":"e_1_2_15_6_1","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/S2468-1253(18)30090-6","article-title":"Bursectomy Versus Omentectomy Alone for Resectable Gastric Cancer (JCOG1001): A Phase 3, Open\u2010Label, Randomised Controlled Trial","volume":"3","author":"Kurokawa Y.","year":"2018","journal-title":"Lancet Gastroenterology & Hepatology"},{"key":"e_1_2_15_7_1","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1016\/j.ejso.2022.11.093","article-title":"Recurrence Patterns After Curative Gastrectomy for Pathological Stage II\/III Gastric Cancer: An Exploratory Analysis of the JCOG1001 Randomized Trial","volume":"49","author":"Toriumi T.","year":"2023","journal-title":"European Journal of Surgical Oncology"},{"key":"e_1_2_15_8_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.bbcan.2022.188719","article-title":"Diffuse Gastric Cancer: Emerging Mechanisms of Tumor Initiation and Progression","volume":"1877","author":"Monster J. 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