Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 May 7;9(3):zraf038.
doi: 10.1093/bjsopen/zraf038.

Benefit of splenectomy in distal pancreatectomy for neuroendocrine tumours: multicentre retrospective study

Elise Clément  1 , Pietro Addeo  2 , Alain Sauvanet  3 , Célia Turco  1 , Ugo Marchese  4 , Safi Dokmak  3 , Christophe Laurent  5 , Ahmet Ayav  6 , Olivier Turrini  7 , Laurent Sulpice  8 , Régis Souche  9 , Julie Perinel  10 , David J Birnbaum  11 , Olivier Facy  12 , Johan Gagnière  13 , Lilian Schwarz  14 , Guillaume Piessen  15 , Nicolas Regenet  16 , Antonio Iannelli  17 , Jean Marc Regimbeau  18 , Xavier Lenne  19 , Bruno Heyd  1 , Sébastien Gaujoux  20 , Mehdi El Amrani  21 , Alexandre Doussot  1   22 ; Collaborators
Collaborators, Affiliations
Multicenter Study

Benefit of splenectomy in distal pancreatectomy for neuroendocrine tumours: multicentre retrospective study

Elise Clément et al. BJS Open. .

Abstract

Background: Distal pancreatectomy is frequently indicated for left-sided pancreatic neuroendocrine tumour (NET). When combined lymphadenectomy is warranted, distal pancreatectomy with splenectomy (DPS) is generally advocated to optimize lymph node dissection. The spleen-preserving distal pancreatectomy (SPDP) may represent an alternative approach. This study aimed to evaluate postoperative and oncological results of distal pancreatectomy with and without splenectomy for pancreatic NET.

Methods: This multicentre retrospective study included all distal pancreatectomy for pancreatic NET performed between 2014 and 2018. Patients with functional NET or multiple endocrine neoplasia type 1 were excluded. Indications and results were compared between DPS, distal pancreatectomy according to Kimura (K-SPDP) and distal pancreatectomy according to Warshaw (W-SPDP), before and after propensity score matching (PSM).

Results: Among 251 patients included (108 DPS (43%), 73 K-SPDP (29%), and 70 W-SPDP (28%)), there was no difference in terms of patients' characteristics, surgical approach, and conversion. Tumour size (P = 0.005), grade (P < 0.001) and the number of nodes analysed (P < 0.001) were significantly lower in patients undergoing K-SPDP as compared to W-SPDP or DPS. Apart from a difference in readmission rate (P = 0.002), there was no difference in terms of mortality rate or severe morbidity rate between the three techniques. After PSM comparing DPS (n = 70) and W-SPDP (n = 70), there was no difference in morbidity and mortality rates. R0 resection rate (91% versus 97%; P = 0.165), the number of nodes analysed (8 versus 7; P = 0.495), and median overall survival (P = 0.493) were not different.

Conclusion: In cases of distal pancreatectomy for NET, splenectomy did not seem to improve lymph node dissection or survival. When lymph node dissection associated with distal pancreatectomy is justified, the benefit of splenectomy appears questionable.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Distribution of tumour size according to the type of resection
Fig. 2
Fig. 2
Overall and recurrence-free survival estimates in the whole cohort (n = 251)
Fig. 3
Fig. 3
Overall and recurrence-free survival estimates in patients who underwent DPS or W-SPDP before propensity score matching
Fig. 4
Fig. 4
Overall and recurrence-free survival estimates in patients who underwent DPS or W-SPDP after propensity score matchingDPS, distal pancreatectomy with splenectomy; W-SPDP, Warshaw spleen-preserving distal pancreatectomy.
See this image and copyright information in PMC

References

    1. Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008;26:3063–3072 - PubMed
    1. Kos-Kudla B, Castano JP, Denecke T, Grande E, Kjaer A, Koumarianou A et al. European Neuroendocrine Tumour Society (ENETS) 2023 guidance paper for nonfunctioning pancreatic neuroendocrine tumours. J Neuroendocrinol 2023;35:e13343. - PubMed
    1. Howe JR, Merchant NB, Conrad C, Keutgen XM, Hallet J, Drebin JA et al. The North American Neuroendocrine Tumor Society consensus paper on the surgical management of pancreatic neuroendocrine tumors. Pancreas 2020;49:1–33 - PMC - PubMed
    1. Hang K, Zhou L, Liu H, Huang Y, Zhang H, Tan C et al. Splenic vessels preserving versus Warshaw technique in spleen preserving distal pancreatectomy: a systematic review and meta-analysis. Int J Surg 2022;103:106686. - PubMed
    1. Kristinsson SY, Gridley G, Hoover RN, Check D, Landgren O. Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. Haematologica 2014;99:392–398 - PMC - PubMed

Publication types