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

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Author notes

  1. Maxime Collard and Tiziana Marchese have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepato-Pancreatico-Biliary Surgery, Pôle des maladies de l’Appareil Digestif, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France

    Maxime Collard MD, Tiziana Marchese MD, François Cauchy MD, Safi Dokmak MD, Olivier Soubrane MD, PhD & Alain Sauvanet MD

  2. Departments of Pathology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France

    Nathalie Guedj MD, PhD

  3. Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France

    Caroline Chassaing MD & Maxime Ronot MD, PhD

  4. Université Paris Diderot, Paris, France

    Nathalie Guedj MD, PhD, Maxime Ronot MD, PhD, Olivier Soubrane MD, PhD & Alain Sauvanet MD

Authors
  1. Maxime Collard MD
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  2. Tiziana Marchese MD
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  3. Nathalie Guedj MD, PhD
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  4. François Cauchy MD
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  9. Alain Sauvanet MD
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Correspondence to Alain Sauvanet MD.

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Collard, M., Marchese, T., Guedj, N. et al. Is Routine Splenectomy Justified for All Left-Sided Pancreatic Cancers? Histological Reappraisal of Splenic Hilar Lymphadenectomy. Ann Surg Oncol 26, 1071–1078 (2019). https://doi.org/10.1245/s10434-018-07123-8

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  • DOI: https://doi.org/10.1245/s10434-018-07123-8

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