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Outcomes after distal pancreatectomy with or without splenectomy for intraductal papillary mucinous neoplasm: international multicentre cohort study.
Gorris, Myrte; van Bodegraven, Eduard A; Abu Hilal, Mohammad; Bolm, Louisa; Busch, Olivier R; Del Chiaro, Marco; Habib, Joseph; Hasegawa, Kiyoshi; He, Jin; van Hooft, Jeanin E; Jang, Jin-Young; Javed, Ammar A; Kazami, Yusuke; Kwon, Wooil; Lee, Mirang; Liu, Rong; Motoi, Fuyuhiko; Perri, Giampaolo; Saiura, Akio; Salvia, Roberto; Sasanuma, Hideki; Takeda, Yoshinori; Wolfgang, Christopher; Zelga, Piotr; Castillo, Carlos Fernandez-Del; Marchegiani, Giovanni; Besselink, Marc G.
Afiliação
  • Gorris M; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.
  • van Bodegraven EA; Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands.
  • Abu Hilal M; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.
  • Bolm L; Cancer Centre Amsterdam, Amsterdam, the Netherlands.
  • Busch OR; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.
  • Del Chiaro M; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.
  • Habib J; Cancer Centre Amsterdam, Amsterdam, the Netherlands.
  • Hasegawa K; Department of Hepatopancreatobiliary Surgery, University Hospital Southampton, Southampton, UK.
  • He J; Department of Surgery, Foundation Poliambulanza, Brescia, Italy.
  • van Hooft JE; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Jang JY; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.
  • Javed AA; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.
  • Kazami Y; Cancer Centre Amsterdam, Amsterdam, the Netherlands.
  • Kwon W; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
  • Lee M; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Liu R; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
  • Motoi F; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Perri G; Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands.
  • Saiura A; Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • Salvia R; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Sasanuma H; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
  • Takeda Y; Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • Wolfgang C; Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • Zelga P; Faculty of Hepatopancreatobiliary Surgery, First Medical Centre of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
  • Castillo CF; Department of Surgery I, Yamagata University, Yamagata, Japan.
  • Marchegiani G; Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy.
  • Besselink MG; Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan.
Br J Surg ; 111(1)2024 Jan 03.
Article em En | MEDLINE | ID: mdl-38195084
ABSTRACT

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.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Neoplasias Intraductais Pancreáticas Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Br J Surg Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Holanda

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Neoplasias Intraductais Pancreáticas Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Br J Surg Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Holanda