Is Routine Splenectomy Justified for All Left-Sided Pancreatic Cancers? Histological Reappraisal of Splenic Hilar Lymphadenectomy
- Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Pancreatico-Biliary Surgery, Pôle des maladies de l’Appareil Digestif (France)
- Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Departments of Pathology (France)
- Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Radiology (France)
Background: Although splenectomy is recommended during resection for left-sided resectable pancreatic ductal adenocarcinoma (PDAC) to perform lymphadenectomy of station 10 (splenic hilum), no level I evidence justifies this procedure. This study aims to evaluate the rate of lymph node (LN) and contiguous involvement of the splenic hilum in resectable distal PDAC. Methods: We retrospectively reviewed all patients who underwent splenopancreatectomy for PDAC in the past 10 years. Station 10 LN were routinely isolated, and all corresponding microscopic slides were reinterpreted by a pathologist. The computed tomography (CT) results of patients with tumoral involvement of the spleen or splenic hilum by contiguity (TISOSH) and ≤ 10 mm between the tumor and spleen on pathology were blindly reviewed by two radiologists to evaluate CT for diagnosis of TISOSH. Results: We included 110 consecutive patients, including 104 with analyzable station 10 LN. The tumor was N+ in 58 (53%) patients. The median number of LN identified at station 10 was 2.0 ± 3.0. No station 10 LNs were detected in 42 (40%) patients. No patients had tumor-positive LN at station 10. TISOSH was found in nine (8%) patients, and was significantly associated with tail location (p = 0.001), tumor size (p = 0.005), and multivisceral involvement (p = 0.015). For diagnosis of TISOSH, the sensitivity and specificity of CT were respectively 89% and 95% for radiologist 1 and 89% and 100% for radiologist 2. Conclusions: Splenic preservation during resection of distal PDAC may be an option in selected patients with body tumors and no suspected splenic or splenic hilum involvement on preoperative CT.
- OSTI ID:
- 22927865
- Journal Information:
- Annals of Surgical Oncology (Online), Vol. 26, Issue 4; Other Information: Copyright (c) 2019 Society of Surgical Oncology; Country of input: International Atomic Energy Agency (IAEA); ISSN 1534-4681
- Country of Publication:
- United States
- Language:
- English
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