We acknowledge that our study has limitations. First, our conclusions are drawn from a limited sample size of 195 patients. Concomitantly, in addition to the specific differences between the splenectomy and non-splenectomy patient populations described, other factors may have contributed to our conclusions. Furthermore, due to the low number of patients receiving only oxaliplatin (n=21) we caution making definitive conclusions from a subanalysis of patients

receiving only Inhibitors,research,lifescience,medical mytomycin C and only oxaliplatin. Lastly, this study is a retrospective analysis, and therefore is prone to the potential limitations and biases therein. Conclusion Splenectomy ameliorates the hematologic toxicity attendant to hyperthermic intraperitoneal chemotherapy. Further, it significantly reduces the number of patients who require post-operative growth factor support. To our knowledge, this is the first report of this finding. While we do not suggest routine splenectomy as part of cytoreductive Inhibitors,research,lifescience,medical surgery and hyperthermic intraperitoneal chemotherapy, this effect of amelioration of hematologic toxicity should be considered when contemplating

splenectomy during cytoreductive procedures prior to chemoperfusion.
Although its incidence and mortality has declined over the last half-century, gastric cancer remains the fourth most common Inhibitors,research,lifescience,medical cancer and the second most frequent cause of cancer death in the world (1),(2). The American Cancer Society estimates that in 2008, there were 21,500 new cases of gastric cancer and 10,880 deaths in the United States (3). As gastric cancer incidence declines, the frequency of proximal gastric and gastroesophageal junctional adenocarcinomas Inhibitors,research,lifescience,medical continues to rise and has become a Panobinostat significant clinical challenge (4),(5). There is substantial geographic variation in the incidence and mortality of gastric cancer, with the highest rates in East Asia and the lowest in North America (2). H. pylori infection, dietary factors, and smoking patterns Inhibitors,research,lifescience,medical may contribute to these disparities (6)-(9). The survival rates for STK38 gastric cancer are among the worst of any solid tumor. Despite the

success of modern chemotherapy in the treatment of large bowel cancers, the 5-year survival of patients with advanced gastric cancer is 3.1% (1),(4). The role of surgery is also limited as only 23% of stage IV gastric cancer patients receiving a palliative gastrectomy are alive one year after surgery (4). Progress was recently made as treating Her-2-Neu (H2N) over-expressing gastric cancers with Traztuzumab was found to significantly improve survival (10). Identifying additional predictive and prognostic markers is an important step to improving current treatment approaches and extending survival. Two distinct histologic types of gastric cancer, the “intestinal type” and “diffuse type”, have been described (11).