BACKGROUND While distal pancreatectomy with splenectomy (DPS) is the reference treatment for pancreatic body and tail neoplasia, oncological benefits of splenectomy have never been demonstrated. Involvement of spleen, splenic hilum and lymph nodes (LN) was therefore assessed on DPS specimens. METHODS All DPS pancreatic neoplasia specimens obtained in 2 Brussels University Hospitals over 15 years (2004-2018) were reviewed retrospectively, using both preoperative radiological imaging and postoperative pathological analyses of splenic parenchyma, hilar tissue and LN. RESULTS The total of 130 DPS specimens included 85 adenocarcinomas, 37 neuroendocrine neoplasms and 8 other carcinomas. Tumours involved the pancreatic body without tail invasion for 59 specimens (B, Body group), and the pancreatic tail with/without body for 71 (T, Tail group). At pathology, direct splenic and/or hilar involvement was observed in 13 T specimens (13/71, 18.3%), but in none belonging to the Body group. The observed numbers of splenic hilar LN (only reported in 49/130 patients) were low, only one T adenocarcinoma had positive splenic LN in addition to direct splenic involvement. CONCLUSION Splenectomy remains justified during pancreatectomy for neoplasia involving the pancreatic tail, but in case of pancreatic body tumours, its benefits should be questioned in the light of absent splenic LN/parenchymal involvement.

中文翻译：

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胰腺肿瘤的远端胰腺切除术：脾切除术真的有必要吗？手术标本的双中心回顾性分析。

背景虽然胰体尾切除联合脾切除术 (DPS) 是胰腺体部和尾部肿瘤的参考治疗方法，但从未证实脾切除术的肿瘤学益处。因此，在 DPS 标本上评估了脾脏、脾门和淋巴结 (LN) 的受累情况。方法回顾性回顾2家布鲁塞尔大学医院15年来（2004-2018年）获得的所有DPS胰腺肿瘤标本，采用术前放射成像和脾实质、肺门组织和LN的术后病理分析。结果共130个DPS标本包括85个腺癌、37个神经内分泌肿瘤和8个其他癌。59 例（B，体组）肿瘤累及胰体，无尾侵犯，71 例（T，尾组）累及有/无体胰尾。在病理学上，在 13 个 T 标本（13/71，18.3%）中观察到直接脾脏和/或肺门受累，但没有一个属于 Body 组。观察到的脾门 LN 数量（仅在 49/130 例患者中报告）很少，除了直接脾受累外，只有 1 例 T 腺癌有阳性脾 LN。结论 对于累及胰尾的肿瘤，在胰腺切除术期间脾切除术仍然是合理的，但在胰腺体瘤的情况下，鉴于没有脾脏 LN/实质受累，其益处应受到质疑。除了直接累及脾脏外，只有 1 例 T 腺癌的脾脏 LN 阳性。结论 对于累及胰尾的肿瘤，在胰腺切除术期间脾切除术仍然是合理的，但在胰腺体瘤的情况下，鉴于没有脾脏 LN/实质受累，其益处应受到质疑。除了直接累及脾脏外，只有 1 例 T 腺癌的脾脏 LN 阳性。结论 对于累及胰尾的肿瘤，在胰腺切除术期间脾切除术仍然是合理的，但在胰腺体瘤的情况下，鉴于没有脾脏 LN/实质受累，其益处应受到质疑。