• Myrte Gorris, Eduard A van Bodegraven, Mohammad Abu Hilal, Louisa Bolm, Olivier R Busch, Marco Del Chiaro, Joseph Habib, Kiyoshi Hasegawa, Jin He, Jeanin E van Hooft, Jin-Young Jang, Ammar A Javed, Yusuke Kazami, Wooil Kwon, Mirang Lee, Rong Liu, Fuyuhiko Motoi, Giampaolo Perri, Akio Saiura, Roberto Salvia, Hideki Sasanuma, Yoshinori Takeda, Christopher Wolfgang, Piotr Zelga, CastilloCarlos Fernandez-DelCFDepartment of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Giovanni Marchegiani, and Marc G Besselink.
• Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.
• Br J Surg. 2024 Jan 3; 111 (1).

BackgroundInternational 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.MethodsAn 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.ResultsOverall, 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).ConclusionThis 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.

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