BACKGROUBD: Although splenic preservation with distal pancreatectomy (DP) has recently been described, the value of this technique in terms of short and long term morbidity for patients with benign or low grade malignant tumors (LGMT) is controversial. This study compares the perioperative course following splenectomy (SP) or splenic preservation (SPP) in patients with distal pancreatic lesions other than adenocarcinoma .
METHODS: From a prospective database, 372 patients undergoing pancreatectomy for lesions other than adenocarcinoma between October 1983 and July 2000 were identified. After excluding those who had other major organ resection, 125 patients had DP with or without splenectomy. Demographic, clinicopathologic and operative variables were reviewed. Mann-Whitney and Chi-Square tests were applied for statistical significance.
RESULTS: There were 43 males and 82 females with a median age of 64 years (range 22-84). Pathology included 45 (36%) neuroendocrine tumors, 44 (35%) benign cystic tumors, 9 (7.2%) pancreatitis, 8 (6.5%) intraductal papillary neoplasms, 7 (5.6%) metastatic tumors, and 12 (9.6%) other LGMTs. SP was performed in 79 (63%) and SPP in 46 (37%). Perioperative complications occurred in 40/79 (50.6%) patients undergoing SP compared to18/46 (39.1%) with SPP (p=0.21). Perioperative infectious complications were 22/79 (27.8%) for SP and 4/46 (8.7%) for SPP (p=0.011). Median postoperative stay (los), length of surgery (losurg), estimated blood loss (EBL), blood transfused (Blood tx), and mortality (M) are listed in the table below. Median tumor size was significantly larger with SP (4.9cm) compared to SPP (2.9cm), but size did not correlate with complications, postoperative stay, or EBL. Survival for patients with tumors was similar in both groups.
CONCLUSIONS: This study suggests that splenic preservation is safe and appears to be associated with a reduction in perioperative infectious complications and length of hospital stay. We believe that splenic preservation should be considered in this group of patients. Further studies are required to assess the long-term implications of this approach.
N los (days) losurg(h) EBL Blood tx(u) M(%)
SP 79 9* (5-41) 3.1(1-7) 600*(50-3250) 0 (0-13) 2 (2.5%)
SPP 46 7* (5-26) 2.9(1-6) 350*(50-2000) 0 (0-8) 0 (0%)