Abstracts
1998 Digestive Disease Week
#1026
THE IMPACT OF SPLENECTOMY ON OUTCOME AFTER RESECTION OF PANCREATIC ADENOCARCINOMA. R.E. Schwarz, L.E. Harrison, D.S. Klimstra, M.F. Brennan City of Hope National Medical Center, Duarte, CA, and Memorial Sloan-Kettering Cancer Center, New York, NY.
Background: Splenectomy (SPL) at the time of resection of esophageal, gastric, or colon cancer has been correlated with inferior long-term survival. No such effect has yet been demonstrated for pancreatic cancer.
Methods: Patients undergoing resection of pancreatic adenocarcinoma with curative intent at Memorial Sloan-Kettering Cancer Center between 10/1983 and 10/1995 were identified from a prospective clinical database. The impact of SPL on hospital stay and survival was calculated with uni- and multivariate nonparametric methods.
Results: Of 332 patients undergoing pancreatectomy (PAN), 39 also underwent simultaneous SPL (11.7%). SPL was significantly correlated with distal or total PAN, primary location in tail or body, portal vein invasion or resection, a larger maximal tumor diameter, and an operative blood loss of >2000 ml. Operative mortality or need for recoperations were not affected by SPL. Patients undergoing SPL had a higher median transfusion requirement (2 units versus 1, p=0.002). The median postoperative length of stay was 15 days irrespective of SPL. At a median follow-up of 11.6 months, the median actuarial survival was 10.6 months (SPL) versus 17.3 months (no SPL; p=0.02). On multivariate analysis, SPL emerged as the dominant predictive independent factor for decreased postoperative survival (p=0.008), in addition to the extent of PAN (total) (p=0.01), tumor differentiation (p=0.01), M classification (p=0.02), and the pathological lymph node status (p=0.04).
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SPL
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No SPL
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p value
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Site: body and tail (n)
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29
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14
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< 0.0001
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Site: head (n)
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10
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279
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Median tumor size (cm)
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5
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3.2
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< 0.0001
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Median lymph node count (n)
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17
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16
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0.05
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Reoperations (%)
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23
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12
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0.06
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30-Day / in-hospital mortality (%)
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7.7
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4.1
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N.S.
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Length of stay, median ± S.D. (d)
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15 ± 24
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15 ± 12
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N.S.
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Median survival (m)
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10.6
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17.3
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0.02
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Conclusions: After PAN for pancreatic cancer, SPL has a negative impact on postoperative recovery and on long-term survival, independent of disease-related factors. Unless required due to tumor proximity or invasion, SPL should be avoided in the operative treatment of exocrine pancreatic cancer of any location. 
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
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