Distal Pancreatectomy for Body Pancreatic Ductal Adenocarcinoma: Is Splenectomy Necessary? A Propensity Score Matched Study

Tatiana Codjia; Christian Hobeika; Pierre Platevoet; Riccardo Pravisani; Safi Dokmak; Béatrice Aussilhou; Lancelot Marique; Jérome Cros; François Cauchy; Mickael Lesurtel; Alain Sauvanet

doi:10.1245/s10434-024-15220-0

Distal Pancreatectomy for Body Pancreatic Ductal Adenocarcinoma: Is Splenectomy Necessary? A Propensity Score Matched Study

Ann Surg Oncol. 2024 Mar 25. doi: 10.1245/s10434-024-15220-0. Online ahead of print.

Affiliations

¹ Department of HPB Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, University of Paris Cité, Clichy, France.
² UMR Inserm 1275 CAP Paris-Tech, Hôpital Lariboisière, Université Paris-Cité, Paris, France.
³ Department of Pathology, AP-HP, Beaujon Hospital, University of Paris Cité, Clichy, France.
⁴ Department of HPB Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, University of Paris Cité, Clichy, France. alain.sauvanet@aphp.fr.

PMID: 38526834
DOI: 10.1245/s10434-024-15220-0

Abstract

Background: The value of splenectomy for body localization (≥ 5 cm from spleen hilum) of pancreatic ductal adenocarcinoma (B-PDAC) is uncertain. This study assessed spleen-preserving distal pancreatectomy (SPDP) results for B-PDAC.

Patients and methods: This single-center study included patients who underwent SPDP (Warshaw's technique) or distal splenopancreactomy (DSP) for B-PDAC from 2008 to 2019. Propensity score matching was performed to balance SPDP and DSP patients regarding sex, age, American Society of Anesthesiologists (ASA), body mass index (BMI), laparoscopy, pathological features [American Joint Committee on Cancer (AJCC)/tumor node metastasis classification (TNM)], margins, and neoadjuvant/adjuvant therapies.

Results: A total of 129 patients (64 male, median age 68 years, median BMI 24 kg/m²) were enrolled with a median follow-up of 63 months (95% CI 52-96 months), including 59 (46%) SPDP and 70 (54%) DSP patients. A total of 39 SPDP patients were matched to 39 DSP patients. SPDP patients had fewer harvested nodes (19 vs 22; p = 0.038) with a similar number of positive nodes (0 vs 0; p = 0.237). R0 margins were achieved similarly in SPDP and DSP patients (75% vs 71%; p = 0.840). SPDP patients were associated with decreased comprehensive complication index (CCI, 8.7 vs 16.6; p = 0.004), rates of grade B/C postoperative pancreatic fistula (POPF, 14% vs 29%; p = 0.047), and hospital stay (11 vs 16 days; p < 0.001). SPDP patients experienced similar disease-free survival (DFS, 5 years: 38% vs 32%; p = 0.180) and overall survival (OS, 5 years 54% vs 44%; p = 0.710). After matching, SPDP patients remained associated with lower CCI (p = 0.034) and hospital stay (p = 0.028) while not associated with risks of local recurrence (HR 0.85; 95% CI 0.28-2.62; p = 0.781), recurrence (HR 1.04; 95% CI 0.61-1.78; p = 0.888), or death (HR 1.20; 95% CI 0.68-2.11; p = 0.556).

Conclusion: SPDP for B-PDAC is associated with less postoperative morbidity than DSP, without impairing oncological outcomes.

Keywords: Body pancreatic ductal adenocarcinoma; Distal pancreatectomy; Spleen preservation; Splenectomy.