A retrospective, multicentric, nationwide analysis of the impact of splenectomy on survival of pancreatic cancer patients.

IF 2.1 3区医学 Q2 SURGERY

Langenbeck's Archives of Surgery Pub Date : 2024-12-22 DOI:10.1007/s00423-024-03570-y

Maximilian Kießler, Carsten Jäger, Carmen Mota Reyes, Ilaria Pergolini, Stephan Schorn, Rüdiger Göß, Okan Safak, Marc E Martignoni, Alexander R Novotny, Waldemar Uhl, Jens Werner, Michael Ghadimi, Werner Hartwig, Reinhard Ruppert, Tobias Keck, Christiane J Bruns, Karl-Jürgen Oldhafer, Andreas Schnitzbauer, Christoph-Thomas Germer, Florian Sommer, Sören Torge Mees, Maximilian Brunner, Jörg Köninger, Tim R Glowka, Jörg C Kalff, Christoph Reißfelder, Detlef K Bartsch, Thomas Kraus, Winfried Padberg, Pompiliu Piso, Bernhard J Lammers, Hagen Rudolph, Christian Moench, Stefan Farkas, Helmut Friess, Güralp O Ceyhan, Ihsan Ekin Demir

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引用次数: 0

Abstract

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.

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脾切除术对胰腺癌患者生存影响的回顾性、多中心、全国性分析。

目的：由于技术原因、淋巴结清扫及手术根治性等原因，在胰全切及胰远端切除术中经常行脾切除术。然而，脾脏作为一种重要的免疫功能器官，其切除与癌症发病率增加和某些癌症实体的预后恶化有关(血液学99:392-398,2014；中华口腔外科杂志；2008；食道疾病（21）：334-339,2008)。脾切除术对胰腺癌的影响尚不明确[J] .中华外科杂志，1998:516-521；中华外科杂志，2019(5):344 - 344。方法：因此，我们使用德国普通和内脏外科学会的StuDoQ|胰腺登记处，比较了2015年至2021年间接受全胰腺切除术或远端胰腺切除术（Sp）或未行脾切除术（NoSp）的193例胰腺癌患者的结果。此外，我们将我们的数据整合到现有文献中，对胰腺癌患者脾切除术的研究进行meta分析。结果：Sp组和NoSp组在组织病理学参数、检查或影响淋巴结数量、残留肿瘤状态或术后发病率和死亡率方面没有差异。我们观察到，在行保脾手术的胰腺癌患者中，行全胰腺切除术的患者生存期明显延长（中位生存期：9.6个月对17.3个月，p = 0.03）。在该组中，脾切除术被确定为缩短总生存期的独立危险因素[HR (95%CI): 2.38(1.03 - 6.8)]。在现有文献的荟萃分析中，结合我们的数据，我们证实脾切除术是胰腺癌患者接受全胰腺切除术、远端胰腺切除术或胰头切除术的总生存期缩短的危险因素[HR (95%CI): 1.53(1.11 - 1.95)]。结论：在这里，我们报告了脾脏切除与胰腺癌患者全胰腺切除术的生存率之间的强相关性。这应该鼓励胰腺外科医生批判性地评估脾切除术在全胰腺切除术中的作用，并引起进一步的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.