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

Collard, M.; Marchese, Tiziana; Guedj, Nathalie; Cauchy, François; Chassaing, Caroline; Ronot, Maxime; Dokmak, Safi; Soubrane, Olivier; Sauvanet, Alain

doi:10.1245/s10434-018-07123-8

Cited by 31 publications

(19 citation statements)

References 28 publications

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“…Recently, Collard et al reported that lymph nodes located in station 10 (splenic hilum) were always metastasis-free in left-sided pancreatic ductal adenocarcinoma cases. The tumoral involvement of the spleen or splenic hilum was observed in only 8% of cases, which could be accurately predicted by computed tomography and intraoperative findings [71]. The results of this study therefore suggest that routine splenectomy may not be mandatory during DP for pancreatic ductal adenocarcinoma.…”

Section: Choice Of Spleen Preservationmentioning

confidence: 70%

Improvement in distal pancreatectomy for tumors in the body and tail of the pancreas

2021

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Background Pancreatic resections are complex and technically challenging surgical procedures. They often come with potential limitations to high-volume centers. Distal pancreatectomy is a relatively simple procedure in most cases. It facilitates the development of up-to-date minimally invasive surgical procedures in pancreatic surgery including laparoscopic distal pancreatectomy and robot-assisted distal pancreatectomy. Main body To obtain a desirable long-term prognosis, R0 resection and adequate lymphadenectomy are crucial to the surgical management of pancreatic cancer, and they demand standard procedure and multi-visceral resection if necessary. With respect to combined organ resection, progress has been made in evaluating and determining when and how to preserve the spleen. The postoperative pancreatic fistula, however, remains the most significant complication of distal pancreatectomy, with a rather high incidence. In addition, a safe closure of the pancreatic remnant persists as an area of concern. Therefore, much efforts that focus on the management of the pancreatic stump have been made to mitigate morbidity. Conclusion This review summarized the historical development of the techniques for pancreatic resections in recent years and describes the progress. The review eventually looked into the controversies regarding distal pancreatectomy for tumors in the body and tail of the pancreas.

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Section: Choice Of Spleen Preservationmentioning

confidence: 70%

Improvement in distal pancreatectomy for tumors in the body and tail of the pancreas

2021

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“…Conventionally, DPS is considered the reference operation for left-sided pancreatic cancer to obtain a negative surgical margin. Recently, Navez et al [ 32 ] and Collard et al [ 33 ] reported that direct splenic involvement was not common in left-sided pancreatic cancers, especially pancreatic body cancers. Perhaps we should consider the decision of splenectomy much more from a biological perspective rather than a surgical perspective.…”

Section: Discussionmentioning

confidence: 99%

Dynamic hematological changes in patients undergoing distal pancreatectomy with or without splenectomy: a population-based cohort study

et al. 2020

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Background The clinical outcomes of patients who received distal pancreatectomy with splenectomy (DPS) and spleen-preserving distal pancreatectomy (SPDP) have been generally investigated. However, postoperative hematological changes after distal pancreatectomy with or without splenectomy are poorly understood. Methods Information from patients undergoing distal pancreatectomy (DP) between January 2014 and June 2019 at a single institution was reviewed. A linear mixed-effects model was used to compare dynamic hematological changes between different groups. Results A total of 302 patients who underwent DP were enrolled. In the long term, most postoperative hematological parameters remained significantly higher than preoperative levels in the DPS group, while postoperative lymphocyte, monocyte, basophil, and platelet levels returned to preoperative levels in the SPDP group. All postoperative hematological parameters except for red blood cell count and serum hemoglobulin level were significantly higher in the DPS group than in the SPDP group. There were no significant differences in hematological changes between the splenic vessel preservation (SVP) and Warshaw technique (WT) groups. Conclusions Postoperative hematological changes were significantly different between the DPS and SPDP groups. Compared to DPS, SPDP reduced abnormal hematological changes caused by splenectomy. SVP and WT were comparable in terms of postoperative hematological changes.

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“…Conventionally, DPS is considered the reference operation for leftsided pancreatic cancer to obtain a negative surgical margin. Recently, Navez et al [32] and Collard et al [33] reported that direct splenic involvement was not common in left-sided pancreatic cancers, especially pancreatic body cancers. Perhaps we should consider the decision of splenectomy much more from a biological perspective rather than a surgical perspective.…”

Section: Discussionmentioning

confidence: 99%

Dynamic hematological changes in patients undergoing distal pancreatectomy with or without splenectomy: a population-based cohort study

Cui

Liu

Zheng

et al. 2020

Preprint

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Background: The clinical outcomes of distal pancreatectomy with splenectomy (DPS) and spleen-preserving distal pancreatectomy (SPDP) patients have been generally investigated. However, postoperative hematological changes after distal pancreatectomy with or without splenectomy are poorly understood. Methods: Information from patients undergoing distal pancreatectomy (DP) between January 2014 and June 2019 at a single institution was reviewed. A linear mixed-effect model was used to compare dynamic hematological changes between different groups. Results: In total, 302 patients who underwent DP were enrolled. In the long term, most postoperative hematological parameters remained significantly higher than preoperative levels in the DPS group, while postoperative lymphocyte, monocyte, basophil, and platelet levels returned to preoperative levels in the SPDP group. All postoperative hematological parameters except for red blood cell count and serum hemoglobulin level were significantly higher in the DPS group than in the SPDP group. There were no significant differences in hematological changes between the splenic vessel preservation (SVP) and Warshaw technique (WT) groups. Conclusions: Postoperative hematological changes were significantly different between the DPS and SPDP groups. Compared to DPS, SPDP reduced abnormal hematological changes caused by splenectomy. SVP and WT were comparable in terms of postoperative hematological changes.

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

Cited by 31 publications

References 28 publications

Improvement in distal pancreatectomy for tumors in the body and tail of the pancreas

Improvement in distal pancreatectomy for tumors in the body and tail of the pancreas

Dynamic hematological changes in patients undergoing distal pancreatectomy with or without splenectomy: a population-based cohort study

Dynamic hematological changes in patients undergoing distal pancreatectomy with or without splenectomy: a population-based cohort study

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