1. Distal pancreatectomy for pancreatic neoplasia: is splenectomy really necessary? A bicentric retrospective analysis of surgical specimens
- Author
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Lancelot Marique, Mina Komuta, Nicky D'Haene, Catherine Hubert, Benoit Navez, Calliope Maris, Julie Navez, Jean Closset, Jean-Luc Van Laethem, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, and UCL - (SLuc) Service d'anatomie pathologique
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Splenectomy ,Spleen ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Pancreatectomy ,Internal medicine ,Parenchyma ,medicine ,Humans ,Pathological ,Retrospective Studies ,Hepatology ,business.industry ,medicine.disease ,Pancreatic Neoplasms ,medicine.anatomical_structure ,Splenic Hilum ,030220 oncology & carcinogenesis ,Adenocarcinoma ,030211 gastroenterology & hepatology ,Lymph ,business - Abstract
Background While distal pancreatectomy with splenectomy (DPS) is the reference treatment for pancreatic body and tail neoplasia, oncological benefits of splenectomy have never been demonstrated. Involvement of spleen, splenic hilum and lymph nodes (LN) was therefore assessed on DPS specimens. Methods All DPS pancreatic neoplasia specimens obtained in 2 Brussels University Hospitals over 15 years (2004–2018) were reviewed retrospectively, using both preoperative radiological imaging and postoperative pathological analyses of splenic parenchyma, hilar tissue and LN. Results The total of 130 DPS specimens included 85 adenocarcinomas, 37 neuroendocrine neoplasms and 8 other carcinomas. Tumours involved the pancreatic body without tail invasion for 59 specimens (B, Body group), and the pancreatic tail with/without body for 71 (T, Tail group). At pathology, direct splenic and/or hilar involvement was observed in 13 T specimens (13/71, 18.3%), but in none belonging to the Body group. The observed numbers of splenic hilar LN (only reported in 49/130 patients) were low, only one T adenocarcinoma had positive splenic LN in addition to direct splenic involvement. Conclusion Splenectomy remains justified during pancreatectomy for neoplasia involving the pancreatic tail, but in case of pancreatic body tumours, its benefits should be questioned in the light of absent splenic LN/parenchymal involvement.
- Published
- 2019