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Introduction: Distal pancreatectomy and splenectomy (DPS) is the procedure of choice for the surgical treatment of ductal adenocarcinoma (PDA) localized to the body and tail of the pancreas. Due to a lack of early symptoms, patients with distal pancreatic lesions can present at an advanced disease stage with large tumors. Splenic vein thrombosis (SVT) can occur in these patients secondary to direct tumor invasion or peri-tumoral inflammation. SVT is most commonly associated with chronic pancreatitis and little is known regarding its implications for patients with PDA. This study documents our institution’s experience with SVT in patients undergoing DPS for PDA and examines it’s effect on postoperative outcomes.

Methods: In this retrospective cohort study, we queried our pancreatic surgery database to identify all patients who underwent DPS from October 2005 to June 2011. These cases were evaluated for evidence of preoperative SVT through review of clinical records and imaging studies (CT, MRI, endoscopic ultrasound). Perioperative outcomes for patients undergoing DPS for PDA with and without SVT were compared.

Results: A total of 284 DPS were performed during the study period. Of these, 70 were for patients with PDA and were distributed into 27 (39%) who had preoperative SVT and 43 (61%) who did not. Both groups had similar demographic characteristics (Table). The median estimated blood loss was significantly higher in the SVT group versus the non- SVT group (675mL vs. 250mL, p<0.001). Although the overall morbidity rate was similar between groups (48% vs 56%, p=NS respectively), the group with SVT had significantly higher rates of serious complications, such as pancreatic fistula (33% vs 7%, p<0.01) and delayed gastric emptying (15% vs 0%, p<0.05). Tumor pathology was similar between groups with the SVT group having 67% T3 stage and 52% lymph node positive tumors while the non-SVT group had 56% T3 stage and 56% lymph node positive tumors. The median postoperative length of stay in the hospital (6 days) and readmission rates (30% vs 28%, p=NS) were similar between groups. Neither group had a perioperative mortality within 30 days of surgery. However, one-year survival for patients with SVT was reduced compared to the non-SVT group (52% vs 76%, p = 0.08), a difference that approached significance.

Conclusions: DPS for PDA can be performed safely in patients with preoperative SVT, but our findings reveal higher rates of intraoperative blood loss, pancreatectomy-specific complications, and suggests lower long term survival rates.

	Total n (%)	SVT n (%)	without SVT n (%)	p-value
Total	70 (100%)	27 (39%)	43 (61%)
Preoperative Demographics
Age (years)	67	63	68	<0.05
Male	42 (60%)	18 (67%)	24 (56%)	NS
BMI	26.1	24.5	26.9	NS
DM	20 (29%)	7 (26%)	13 (30%)	NS
Tobacco Use*	26 (36%)	10 (37%)	16 (37%)	NS
EBL* (ml)	400	675	250	<0.0001
Complications**
Any Complication	37 (53%)	13 (48%)	24 (56%)	NS
P. Fistula	12 (17%)	9 (33%)	3 (7%)	<0.01
DGE	4 (6%)	4 (15%)	0 (0%)	<0.05
Chyle Leak	3 (4%)	1 (4%)	2 (5%)	NS
Intra-abdominal Abscess	4 (6%)	2 (7%)	2 (5%)	NS
Cardiac	6 (9%)	1 (4%)	5 (12%)	NS
UTI	5 (7%)	4 (15%)	1 (2%)	NS
Wound Infection	11 (16%)	4 (15%)	7 (16%)	NS
Sepsis	3 (4%)	2 (7%)	1 (2%)	NS
C. diff. colitis	2 (3%)	0 (0%)	2 (5%)	NS
DVT/PE	3 (4%)	2 (7%)	1 (2%)	NS
Pulmonary	6 (9%)	1 (4%)	5 (12%)	NS
Length of Postoperative Hospital Stay (days)	6	6	6	NS
Pathology
T3 Stage	42 (60%)	18 (67%)	24 (56%)	NS
Lymph Node Positive	38 (54%)	14 (52%)	24 (56%)	NS
Readmission	20 (29%)	8 (30%)	12 (28%)	NS
1-year Overall Survival***	36 (67%)	11 (52%)	25 (76%)	NS

DM, Diabetes Mellitus; EBL, Estimated Blood Loss; SVT, Splenic Vein Thrombosis; P. Fistula, Pancreatic Fistula; UTI, Urinary Tract Infection; DGE, Delayed Gastric Emptying; C. diff. colitis, Clostridium difficile colitis; DVT/PE, Deep Vein Thrombosis/Pulmonary Embolism. *Tobacco Use data not available for 2 patients, EBL data not available for 4 patients. Total numbers for these variables exclude these patients **Number of patients with one or more complications. ***Only includes patients with date of surgery from 10/2005-06/2011.