Removal of the spleen (splenectomy) is routinely performed during surgery to treat left-sided (body and tail) cancer of the pancreas (PDAC). This is mainly to ensure adequate removal of lymph nodes (LNs) in the area between the spleen and the pancreas (the perisplenic hilum). The relevance of this extended lymphadenectomy and its impact on survival is poorly studied. Additionally, splenectomy is associated with risks, such as severe life-threatening infections (overwhelming post-splenectomy sepsis). The incidence of tumor-positive LNs in the perisplenic hilum is poorly described. The limited available number of studies are small, retrospective and only examine the splenic hilum (LN station 10) instead of the complete the perisplenic hilum that remains in place when the spleen is preserved in left-sided pancreatic surgery. Spleen-preservation in left-sided pancreatic resections for PDAC goes against current treatment guidelines and is therefore not common practice in The Netherlands. Two foreign studies suggest that spleen-preservation does not worsen oncological outcomes and leads to fewer postoperative complications. However, these studies are retrospective, single-center and only include a very small number of patients and are therefore not providing enough evidence to change current guidelines.
The SPLENDID-project focuses on evaluating the oncological safety of spleen-preservation in patients with left-sided PDAC. This prospective cohort study will include all patients undergoing a left-sided pancreatectomy with splenectomy. The surgical specimen will be cut at the precise level where spleen-preservation would occur. The total number of LNs and tumor involvement of LNs in both parts of the specimen will be collected and compared. The SPLENDID-project will be performed in over 30 European centers including all 17 centers of the Dutch Pancreatic Cancer Group.
Prof Marc Besselink, department of surgery
Dr. Arantza Farina Sarasqueta, department of pathology
Dr. Jony van Hilst, department of surgery
Drs. Caró Bruna, PhD candidate department of surgery