The indication for (obligatory) splenectomy in case of total gastrectomy for gastric carcinoma remains controversial. Overall, an increase of morbidity, but not of postoperative mortality following splenectomy is assumed. Among the prognostic parameters, splenectomy is not an independent indicator. The indication for splenectomy results from the depth of tumor infiltration, tumor site and pattern of lymph node metastases. In T1/2 lesions of the mid-stomach and of the antrum the spleen may be preserved, but splenectomy should be performed in all advanced tumors, carcinomas of proximal sites and infiltration of the spleen. Surgical radicality may be further increased by simultaneous left pancreatic or left upper quadrant resection.