Is splenectomy really necessary in left pancreatectomy for pancreatic neoplasia? A bicentric retrospective analysis of surgical specimens

Abstract

Background: Although left pancreatectomy with splenectomy (LPS) is considered as the gold standard for the treatment of neoplasia from the pancreatic body and tail, the oncological benefit of spleen removal has never been demonstrated. This study aimed to assess the involvement of the spleen, the splenic hilum and lymph nodes (LN) on pathological specimens of LPS for neoplasia. Methods: All patients undergoing LPS for pancreatic carcinoma or neuroendocrine neoplasia in 2 tertiary centers were retrospectively reviewed. Pathological analysis of the splenic parenchyma, the hilar tissue and the peripancreatic and splenic hilar lymph nodes (LN) was reviewed, such as the pancreatic tumor location on preoperative imaging. Results: Between 2004 and 2018, 161 patients had a LPS for pancreatic neoplasia, including 114 adenocarcinoma, 38 neuroendocrine neoplasia and 9 other rare carcinoma. Tumor was located into the pancreatic body without infiltrating the tail in 81 patients (group Body), and involved the tail with or without the body in 80 patients (group Tail). The median number of LN found on specimens was 15 (± 16). Positive LN were present in 48% (39/81) and 45% (36/81) of patients from groups Body and Tail, respectively. Splenic hilar LN were not frequent, and were positive in only 1 patient from group Tail (1%) and no patient from group Body. Direct involvement of the splenic parenchyma and/or hilum was observed in 9 patients from group Tail (11%) and absent in group Body. Conclusions: According to the Results of the present study, the value of performing a splenectomy in patients with a neoplasia located into the pancreatic body should be questioned. Resection of the splenic vessels remains essential for regional lymphadenectomy, so the splenic preservation using the Warshaw technique could be a good option.