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Proposal for splenectomy-omitting radical distal pancreatectomy in well-selected left-sided pancreatic cancer: multicenter survey study

Authors
 Sung Hoon Kim  ;  Chang Moo Kang  ;  Sohei Satoi  ;  Masayuki Sho  ;  Yoshiharu Nakamura  ;  Woo Jung Lee 
Citation
 JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES, Vol.20(3) : 375-381, 2013 
Journal Title
 JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 
ISSN
 1868-6974 
Issue Date
2013
MeSH
Adenocarcinoma/surgery* ; Adult ; Aged ; Chi-Square Distribution ; Female ; Humans ; Japan ; Lymphatic Metastasis ; Male ; Middle Aged ; Pancreatectomy/methods* ; Pancreatic Neoplasms/surgery* ; Pilot Projects ; Prospective Studies ; Retrospective Studies ; Splenectomy/methods* ; Treatment Outcome
Keywords
Pancreatic cancer ; Lymph node metastasis ; Distal pancreatectomy ; Splenectomy ; Sple
Abstract
BACKGROUND: When distal pancreatectomy is carried out for left-sided pancreatic cancer, splenectomy is usually performed not only for margin-negative resection but also for effective clearance of the splenic hilar lymph nodes (LNs). However, the incidence of splenic hilar LN metastasis in these patients has not been definitively determined. METHODS: From April 2010 to June 2011, in a pilot study, we analyzed the medical records of twelve patients who had undergone radical antegrade modular pancreatosplenectomy. Potential remnant soft tissue around the splenic hilum, which would be left following an extended Warshaw's procedure, was dissected and sent to a pathologist. Three Japanese medical centers conducted a retrospective survey of splenic hilar lymph node metastasis in left-sided pancreatic cancer to support our study. RESULTS: In the pilot study, all twelve patients had adenocarcinoma with a median tumor size of 2 cm. Six patients had LN metastasis and a median number of 4 splenic hilar LNs were evaluated; however, no splenic hilar LN metastasis was noted. In the Japanese multicenter survey (n = 85), only four patients had splenic LN metastasis. Small (<3 cm) and proximal (neck/body) left-sided pancreatic cancer might not be associated with splenic hilar LN metastasis (P < 0.05). CONCLUSIONS: In well-selected left-sided pancreatic cancer, the incidence of splenic hilar LN metastasis is low enough that splenectomy-omitting radical distal pancreatectomy would be feasible. The rationale for routine splenectomy should be re-evaluated, and the oncologic effects of the preserved spleen need to be investigated further.
Full Text
http://link.springer.com/article/10.1007%2Fs00534-012-0549-z
DOI
10.1007/s00534-012-0549-z
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Lee, Woo Jung(이우정) ORCID logo https://orcid.org/0000-0001-9273-261X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/86578
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