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Objectives: Major abodminal vessel invasion by PDAC in the head of the gland typically represents more advanced disease not amenable to surgical resection. During distal pancreatectomy for PDAC of the body or tail, the splenic vessels are routinely removed for tumor clearance and lymphadenectomy. However, little is known about the biologic significance of splenic artery and vein involvement in PDAC of the body or tail and we hypothesize that it may be an adverse prognostic factor.
Methods: All cases of distal pancreatectomy for PDAC at a single institution between 2000-2010 were retrospectively reviewed from an IRB-approved database. Preoperative computed tomography (CT) imaging was re-reviewed by a single radiologist and splenic artery and vein involvement was graded as none, abutment, encasement or occlusion. Demographic, laboratory, operative, pathological, and outcome data were collected and correlated to the degree of splenic vessel involvement. Statistical analysis was performed using a Chi-Square with Fisher's exact test and survival compared by the method of Kaplan-Meier with log rank test.
Results: 46 patients were identified, of which 44 had preoperative cross-sectional imaging available for evaluation to make up the study cohort. 39 (89%) patients had radiographic tumor involvement of the splenic vein (23 abutment, 6 encasement, 10 occlusion) while 32 (73%) patients had tumor involvement of the splenic artery (20 abutment, 12 encasement, none with occlusion). 28 patients had both arterial and splenic involvement while three patients had neither. There was no significant difference in margin positivity, perineural or lymphovascular invasion between patients with or without splenic vessel involvement. However, splenic artery encasement correlated with lymph node positivity (p<0.02). Splenic artery but not vein encasement or occlusion was associated with a significantly worse overall survival (OS) when compared to abutment or no involvement (median OS 15 months vs 31 months, p<0.04).
Conclusions:
Patients with PDAC of the body or tail presenting with radiographic encasement of the splenic artery but not the vein have a worse prognosis and should be considered for additional treatment such as neoadjuvant therapy prior to an attempt at resection.