Distal Pancreatectomy for Body-pancreatic Ductal Adenocarcinoma: Is Splenectomy Necessary?
(2023)
Files
No attached file found for this publication.
Details
- Authors
- Abstract
- Purpose: The value of splenectomy during distal pancreatectomy (DP) for body-pancreatic ductal adenocarcinoma (B-PDAC) has not been evaluated. This study aimed to assess the impact of spleen preservation (SP+) on morbidity and oncological outcomes following DP for B-PDAC. Method: Single-center cohort study including patients who underwent DP with SP+ according to Warshaw’s technique and DP with splenectomy (SP-) for B-PDAC from 2008 to 2019. Exclusion criteria were: distance <5cm between tumor and spleen hilum and multi-organ resection. Primary endpoints were disease-free (DFS) and overall survival (OS). Secondary endpoints were 90-day morbi-mortality using comprehensive complication index (CCI) and ISGPS definitions. Results: 129 patients were enrolled including 59 (46%) SP+ and 70 (54%) with splenectomy (SP-). Median age and BMI were 68 years and 24 kg/m2. SP+ and SP- patients were comparable regarding preoperative variables including neoadjuvant treatment (overall=24%), and laparoscopic approach (overall=39%). There was no 90-day mortality. Hospital stay was shorter after SP+ (11 vs. 16 days; p<0.001). SP+ patients experienced a lower CCI (8.7 vs. 16.6; p=0.004) with lower rates of grade B/C POPF (14% vs. 29%; p= 0.039) and deep organ space abscess (5% vs. 19%; p=0.041). The rate of R0 margins was similar in SP+ and SP- patients (75% vs. 71%, respectively; p=0.840), as well as invaded/harvested node ratio (0.0% vs. 0.0%; p=0.246), and AJCC staging (p=0.200). After a median follow-up of 63 months (IC95%:52-96), 1- ,3- and 5-year DFS and OS were 77%, 50% and 43% and 91%, 63% and 47%, respectively. On multivariate analysis, after doubly-robust adjustments on preoperative data, SP+ was associated with a better DFS (HR=0.315 [IC95%: 0.146-0.678]; p=0.0032), and had no influence on OS (HR=0.664 [IC95%: 0.317-1.392]; p=0.2782). After doubly-robust adjustments on pathological data and perioperative treatment, SP+ had no negative impact on DFS (HR=0.58 [IC95%: 0.3-1.13]; p=0.111) or OS (HR=0.9 [IC95%: 0.47-1.71]; p=0.738). Conclusion: SP+ DP for B-PDAC is associated with less postoperative morbidity than splenectomy, without impairing oncological outcomes. This study provides a rational to evaluate SP+ DP as a potential new oncological standard in B-PDAC.
- Affiliations
Citations
Codjia, T., Hobeika, C., Platevoet, P., Pravisani, R., Dokmak, S., Aussilhou, B., Marique, L., Cros, J., Cauchy, F., Lesurtel, M., & Sauvanet, A. (2023). Distal Pancreatectomy for Body-pancreatic Ductal Adenocarcinoma: Is Splenectomy Necessary? HPB, 25, S297. https://doi.org/10.1016/j.hpb.2023.07.200 (Original work published 2023)