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Multicenter Study
. 2024 Jan 3;111(1):znad424.
doi: 10.1093/bjs/znad424.

Outcomes after distal pancreatectomy with or without splenectomy for intraductal papillary mucinous neoplasm: international multicentre cohort study

Myrte Gorris  1   2   3   4 , Eduard A van Bodegraven  1   3   4 , Mohammad Abu Hilal  5   6 , Louisa Bolm  7 , Olivier R Busch  1   3   4 , Marco Del Chiaro  8 , Joseph Habib  9 , Kiyoshi Hasegawa  10 , Jin He  9 , Jeanin E van Hooft  11 , Jin-Young Jang  12 , Ammar A Javed  9 , Yusuke Kazami  10 , Wooil Kwon  12 , Mirang Lee  12 , Rong Liu  13 , Fuyuhiko Motoi  14 , Giampaolo Perri  15 , Akio Saiura  16 , Roberto Salvia  15 , Hideki Sasanuma  17 , Yoshinori Takeda  16 , Christopher Wolfgang  18 , Piotr Zelga  7 , Carlos Fernandez-Del Castillo  7 , Giovanni Marchegiani  15 , Marc G Besselink  1   3   4
Affiliations
Multicenter Study

Outcomes after distal pancreatectomy with or without splenectomy for intraductal papillary mucinous neoplasm: international multicentre cohort study

Myrte Gorris et al. Br J Surg. .

Abstract

Background: International guidelines on intraductal papillary mucinous neoplasm (IPMN) recommend a formal oncological resection including splenectomy when distal pancreatectomy is indicated. This study aimed to compare oncological and surgical outcomes after distal pancreatectomy with or without splenectomy in patients with presumed IPMN.

Methods: An international, retrospective cohort study was undertaken in 14 high-volume centres from 7 countries including consecutive patients after distal pancreatectomy for IPMN (2005-2019). Patients were divided into spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS). The primary outcome was lymph node metastasis (LNM). Secondary outcomes were overall survival, duration of operation, blood loss, and secondary splenectomy.

Results: Overall, 700 patients were included after distal pancreatectomy for IPMN; 123 underwent SPDP (17.6%) and 577 DPS (82.4%). The rate of malignancy was 29.6% (137 patients) and the overall rate of LNM 6.7% (47 patients). Patients with preoperative suspicion of malignancy had a LNM rate of 17.2% (23 of 134) versus 4.3% (23 of 539) among patients without suspected malignancy (P < 0.001). Overall, SPDP was associated with a shorter operating time (median 180 versus 226 min; P = 0.001), less blood loss (100 versus 336 ml; P = 0.001), and shorter hospital stay (5 versus 8 days; P < 0.001). No significant difference in overall survival was observed between SPDP and DPS for IPMN after correction for prognostic factors (HR 0.50, 95% c.i. 0.22 to 1.18; P = 0.504).

Conclusion: This international cohort study found LNM in 6.7% of patients undergoing distal pancreatectomy for IPMN. In patients without preoperative suspicion of malignancy, SPDP seemed oncologically safe and was associated with improved short-term outcomes compared with DPS.

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Conflict of interest statement

J.E.v.H. currently has a role as independent observer for Olympus and has received honoraria from Cook Medical, Boston Scientific, Metronic, and Abbvie. The authors declare no other conflict of interest.

Figures

Fig. 1
Fig. 1
Study flow chart DP, distal pancreatectomy; SPDP, spleen-preserving distal pancreatectomy; DPS, distal pancreatectomy with splenectomy; IPMN, intraductal papillary mucinous neoplasm.
Fig. 2
Fig. 2
Kaplan–Meier estimates of overall survival after spleen-preserving distal pancreatectomy versus distal pancreatectomy with splenectomy in patients without suspected malignancy SPDP, spleen-preserving distal pancreatectomy; DPS, distal pancreatectomy with splenectomy.
See this image and copyright information in PMC

Comment in

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