Abstract
Purpose
Splenic vessel involvement occurs frequently in pancreatic ductal adenocarcinoma (PDAC) of the body and the tail (B/T) but the impact on survival is unknown. We assessed the influence of radiological and pathologic involvement of splenic artery (p-SA +) and vein (p-SV +) on patient outcomes after distal pancreatectomy (DP) for PDAC.
Methods
From 2013 to 2019, all DP for PDAC in five centers were included. Factors associated with overall (OS) and disease-free (DFS) survival were identified.
Results
Among the 76 patients included, 5 (6.6%) had p-SA + only, 11 (14.5%) had p-SV + only, and 24 (31.6%) had both p-SA + and p-SV + . The preoperative CT-scan accuracy to predict p-SV + and p-SA + was high (sensitivity: 91.4% and 82.8%, respectively; negative predictive value: 89.7% and 88.3%, respectively). The 5-year OS and DFS rates were 3.9% and 8.3%, respectively. Multivariate analysis identified splenic vessel involvement (i.e., p-SA + or p-SV + , or both p-SA + and p-SV +) as the only independent factor influencing DFS (HR 4.04; 95% CI [1.22–13.44], p = 0.023). Tumor size ≥ 30 mm was the only independent factor influencing OS (HR 4.04; 95% CI [1.26–12.95], p = 0.019) and was associated with a high risk of p-SA + (p = 0.001) and p-SV + (p < 0.001).
Conclusion
Tumor size ≥ 30 mm and splenic vessel involvement occurred in more than half of the patients who underwent DP for PDAC and had negative impact on long-term survival. Preoperative CT-scan was reliable to identify splenic vessel involvement in B/T PDAC. Large tumor size and radiological splenic vessel involvement could be taken into account to propose a neoadjuvant treatment.
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Data availability
The data that support the findings of this study are available on request from the corresponding author.
Code availability
Analyses were done using SPSS 24.0 (IBM corporation, Armonk, NY).
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Study conception and design: Dominique Gantois, Théophile Guilbaud, and David Jérémie Birnbaum.
Acquisition of data: Dominique Gantois, Théophile Guilbaud, Edouard Girard, Ugo Scemama, Olivier Picaud, Marine Lefevre, Myriam Elgani, and David Jérémie Birnbaum.
Analysis and interpretation of data: Dominique Gantois, Théophile Guilbaud, Zeinab Hamidou, Mircea Chirica, David Fuks, Louise Barbier, and David Jérémie Birnbaum.
Drafting of manuscript: Dominique Gantois, Théophile Guilbaud, Mircea Chirica, David Fuks, Louise Barbier, and David Jérémie Birnbaum.
Critical revision of manuscript: Théophile Guilbaud, Mircea Chirica, David Fuks, Louise Barbier, Vincent Moutardier, Paul Balandraud, and David Jérémie Birnbaum.
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423_2021_2291_MOESM1_ESM.tiff
Supplementary file1 (TIFF 212 KB) Correlation between tumor size and pathological (a) splenic artery involvement, (b) splenic vein involvement. p-SA+, pathological splenic artery involvement; p-SA-, no pathological splenic artery involvement; p-SV+, pathological splenic vein involvement; p-SV-, no pathological splenic vein involvement.
423_2021_2291_MOESM2_ESM.tif
Supplementary file2 (TIF 109 KB) ROC curve analyzing correlation between tumor size and pathological (a) splenic artery involvement, (b) splenic vein involvement. A tumor size ≥ 30 mm had a Se, Sp, PPV and NPV of 79.31%, 55.32%, 52.27% and 81.25%, respectively in predicting SA involvement. A tumor size ≥ 30 mm had a Se, Sp, PPV and NPV of 62.86%, 80.49%, 73.33% and 71.74%, respectively in predicting SV involvement.
423_2021_2291_MOESM3_ESM.tiff
Supplementary file3 (TIFF 640 KB) Incidence of liver metastases regarding (a) splenic artery and (b) splenic vein pathological involvement status. Incidence of peritoneal carcinomatosis regarding (c) splenic artery and (d) splenic vein pathological involvement status. p-SA+, pathological splenic artery involvement; p-SA-, no pathological splenic artery involvement; p-SV+, pathological splenic vein involvement; p-SV-, no pathological splenic vein involvement.
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Gantois, D., Guilbaud, T., Scemama, U. et al. Prognostic impact of splenic vessel involvement and tumor size in distal pancreatectomy for adenocarcinoma: a retrospective multicentric cohort study. Langenbecks Arch Surg 407, 153–165 (2022). https://doi.org/10.1007/s00423-021-02291-w
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DOI: https://doi.org/10.1007/s00423-021-02291-w