TY - JOUR
T1 - A retrospective, multicentric, nationwide analysis of the impact of splenectomy on survival of pancreatic cancer patients
AU - Kießler, Maximilian
AU - Jäger, Carsten
AU - Mota Reyes, Carmen
AU - Pergolini, Ilaria
AU - Schorn, Stephan
AU - Göß, Rüdiger
AU - Safak, Okan
AU - Martignoni, Marc E.
AU - Novotny, Alexander R.
AU - Uhl, Waldemar
AU - Werner, Jens
AU - Ghadimi, Michael
AU - Hartwig, Werner
AU - Ruppert, Reinhard
AU - Keck, Tobias
AU - Bruns, Christiane J.
AU - Oldhafer, Karl Jürgen
AU - Schnitzbauer, Andreas
AU - Germer, Christoph Thomas
AU - Sommer, Florian
AU - Mees, Sören Torge
AU - Brunner, Maximilian
AU - Köninger, Jörg
AU - Glowka, Tim R.
AU - Kalff, Jörg C.
AU - Reißfelder, Christoph
AU - Bartsch, Detlef K.
AU - Kraus, Thomas
AU - Padberg, Winfried
AU - Piso, Pompiliu
AU - Lammers, Bernhard J.
AU - Rudolph, Hagen
AU - Moench, Christian
AU - Farkas, Stefan
AU - Friess, Helmut
AU - Ceyhan, Güralp O.
AU - Demir, Ihsan Ekin
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2025/12
Y1 - 2025/12
N2 - Objective: Splenectomy is regularly performed in total and distal pancreatectomy due to technical reasons, lymph node dissection and radicality of the operation. However, the spleen serves as an important organ for competent immune function, and its removal is associated with an increased incidence of cancer and a worse outcome in some cancer entities (Haematologica 99:392–398, 2014; Dis Colon Rectum 51:213–217, 2008; Dis Esophagus 21:334–339, 2008). The impact of splenectomy in pancreatic cancer is not fully resolved (J Am Coll Surg 188:516–521, 1999; J Surg Oncol 119:784–793, 2019). 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.
AB - Objective: Splenectomy is regularly performed in total and distal pancreatectomy due to technical reasons, lymph node dissection and radicality of the operation. However, the spleen serves as an important organ for competent immune function, and its removal is associated with an increased incidence of cancer and a worse outcome in some cancer entities (Haematologica 99:392–398, 2014; Dis Colon Rectum 51:213–217, 2008; Dis Esophagus 21:334–339, 2008). The impact of splenectomy in pancreatic cancer is not fully resolved (J Am Coll Surg 188:516–521, 1999; J Surg Oncol 119:784–793, 2019). 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.
KW - Distal pancreatectomy
KW - Pancreatic cancer
KW - Splenectomy
KW - Total pancreatectomy
UR - http://www.scopus.com/inward/record.url?scp=85212774126&partnerID=8YFLogxK
U2 - 10.1007/s00423-024-03570-y
DO - 10.1007/s00423-024-03570-y
M3 - Article
AN - SCOPUS:85212774126
SN - 1435-2443
VL - 410
JO - Langenbeck's Archives of Surgery
JF - Langenbeck's Archives of Surgery
IS - 1
M1 - 14
ER -
