A retrospective, multicentric, nationwide analysis of the impact of splenectomy on survival of pancreatic cancer patients.
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Kießler Maximilian, Jäger Carsten, Mota Reyes Carmen, Pergolini Ilaria, Schorn Stephan, Göß Rüdiger, Safak Okan, Martignoni Marc E, Novotny Alexander R, Uhl Waldemar, Werner Jens, Ghadimi Michael, Hartwig Werner, Ruppert Reinhard, Keck Tobias, Bruns Christiane J, Oldhafer Karl-Jürgen, Schnitzbauer Andreas, Germer Christoph-Thomas, Sommer Florian, Mees Sören Torge, Brunner Maximilian, Köninger Jörg, Glowka Tim R, Kalff Jörg C, Reißfelder Christoph, Bartsch Detlef K, Kraus Thomas, Padberg Winfried, Piso Pompiliu, Lammers Bernhard J, Rudolph Hagen, Moench Christian, Farkas Stefan, Friess Helmut, Ceyhan Güralp O, Demir Ihsan Ekin
Аннотация
METHODS: We therefore compared the outcome of 193 pancreatic cancer patients who underwent total or distal pancreatectomy with (Sp) or without splenectomy (NoSp) between 2015 and 2021 using the StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery. In addition, we integrated our data into the existing literature in a meta-analysis of studies on splenectomy in pancreatic cancer patients.
RESULTS: There was no difference between the Sp and NoSp groups regarding histopathological parameters, number of examined or affected lymph nodes, residual tumor status, or postoperative morbidity and mortality. We observed a significantly prolonged survival in pancreatic cancer patients who underwent total pancreatectomy, when a spleen-preserving operation was performed (median survival: 9.6 vs. 17.3 months, p = 0.03). In this group, splenectomy was identified as an independent risk factor for shorter overall survival [HR (95%CI): 2.38 (1.03 - 6.8)]. In a meta-analysis of the existing literature in combination with our data, we confirmed splenectomy as a risk factor for a shorter overall survival in pancreatic cancer patients undergoing total pancreatectomy, distal pancreatectomy, or pancreatic head resection [HR (95%CI): 1.53 (1.11 - 1.95)].
CONCLUSION: Here, we report on a strong correlations between removal of the spleen and the survival of pancreatic cancer patients undergoing total pancreatectomy. This should encourage pancreatic surgeons to critically assess the role of splenectomy in total pancreatectomy and give rise to further investigations.