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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2019

01-04-2019 | Computed Tomography | Pancreatic Tumors

Is Routine Splenectomy Justified for All Left-Sided Pancreatic Cancers? Histological Reappraisal of Splenic Hilar Lymphadenectomy

Authors: Maxime Collard, MD, Tiziana Marchese, MD, Nathalie Guedj, MD, PhD, François Cauchy, MD, Caroline Chassaing, MD, Maxime Ronot, MD, PhD, Safi Dokmak, MD, Olivier Soubrane, MD, PhD, Alain Sauvanet, MD

Published in: Annals of Surgical Oncology | Issue 4/2019

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Abstract

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.
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Metadata
Title
Is Routine Splenectomy Justified for All Left-Sided Pancreatic Cancers? Histological Reappraisal of Splenic Hilar Lymphadenectomy
Authors
Maxime Collard, MD
Tiziana Marchese, MD
Nathalie Guedj, MD, PhD
François Cauchy, MD
Caroline Chassaing, MD
Maxime Ronot, MD, PhD
Safi Dokmak, MD
Olivier Soubrane, MD, PhD
Alain Sauvanet, MD
Publication date
01-04-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-07123-8

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