Outcomes after distal pancreatectomy with or without splenectomy for intraductal papillary mucinous neoplasm: international multicentre cohort study.

Autor:	Gorris M; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.; Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.; Cancer Centre Amsterdam, Amsterdam, the Netherlands., van Bodegraven EA; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.; Cancer Centre Amsterdam, Amsterdam, the Netherlands., Abu Hilal M; Department of Hepatopancreatobiliary Surgery, University Hospital Southampton, Southampton, UK.; Department of Surgery, Foundation Poliambulanza, Brescia, Italy., Bolm L; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Busch OR; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.; Cancer Centre Amsterdam, Amsterdam, the Netherlands., Del Chiaro M; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Habib J; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Hasegawa K; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan., He J; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., van Hooft JE; Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands., Jang JY; Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea., Javed AA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Kazami Y; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan., Kwon W; Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea., Lee M; Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea., Liu R; Faculty of Hepatopancreatobiliary Surgery, First Medical Centre of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China., Motoi F; Department of Surgery I, Yamagata University, Yamagata, Japan., Perri G; Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy., Saiura A; Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan., Salvia R; Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy., Sasanuma H; Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan., Takeda Y; Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan., Wolfgang C; Department of Surgery, NYU Grossman School of Medicine, NewYork, New York, USA., Zelga P; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Castillo CF; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Marchegiani G; Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy., Besselink MG; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.; Cancer Centre Amsterdam, Amsterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	The British journal of surgery [Br J Surg] 2024 Jan 03; Vol. 111 (1).
DOI:	10.1093/bjs/znad424
Abstrakt:	Background: International guidelines on intraductal papillary mucinous neoplasm (IPMN) recommend a formal oncological resection including splenectomy when distal pancreatectomy is indicated. This study aimed to compare oncological and surgical outcomes after distal pancreatectomy with or without splenectomy in patients with presumed IPMN. Methods: An international, retrospective cohort study was undertaken in 14 high-volume centres from 7 countries including consecutive patients after distal pancreatectomy for IPMN (2005-2019). Patients were divided into spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS). The primary outcome was lymph node metastasis (LNM). Secondary outcomes were overall survival, duration of operation, blood loss, and secondary splenectomy. Results: Overall, 700 patients were included after distal pancreatectomy for IPMN; 123 underwent SPDP (17.6%) and 577 DPS (82.4%). The rate of malignancy was 29.6% (137 patients) and the overall rate of LNM 6.7% (47 patients). Patients with preoperative suspicion of malignancy had a LNM rate of 17.2% (23 of 134) versus 4.3% (23 of 539) among patients without suspected malignancy (P < 0.001). Overall, SPDP was associated with a shorter operating time (median 180 versus 226 min; P = 0.001), less blood loss (100 versus 336 ml; P = 0.001), and shorter hospital stay (5 versus 8 days; P < 0.001). No significant difference in overall survival was observed between SPDP and DPS for IPMN after correction for prognostic factors (HR 0.50, 95% c.i. 0.22 to 1.18; P = 0.504). Conclusion: This international cohort study found LNM in 6.7% of patients undergoing distal pancreatectomy for IPMN. In patients without preoperative suspicion of malignancy, SPDP seemed oncologically safe and was associated with improved short-term outcomes compared with DPS. (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)
Databáze:	MEDLINE
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