脾切除术在神经内分泌肿瘤胰体尾切除术中的益处：多中心回顾性研究
Benefit of splenectomy in distal pancreatectomy for neuroendocrine tumours: multicentre retrospective study.
作者信息
Clément Elise, Addeo Pietro, Sauvanet Alain, Turco Célia, Marchese Ugo, Dokmak Safi, Laurent Christophe, Ayav Ahmet, Turrini Olivier, Sulpice Laurent, Souche Régis, Perinel Julie, Birnbaum David J, Facy Olivier, Gagnière Johan, Schwarz Lilian, Piessen Guillaume, Regenet Nicolas, Iannelli Antonio, Regimbeau Jean Marc, Lenne Xavier, Heyd Bruno, Gaujoux Sébastien, El Amrani Mehdi, Doussot Alexandre
机构信息
Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, Besançon, France.
Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
出版信息
BJS Open. 2025 May 7;9(3). doi: 10.1093/bjsopen/zraf038.
BACKGROUND
Distal pancreatectomy is frequently indicated for left-sided pancreatic neuroendocrine tumour (NET). When combined lymphadenectomy is warranted, distal pancreatectomy with splenectomy (DPS) is generally advocated to optimize lymph node dissection. The spleen-preserving distal pancreatectomy (SPDP) may represent an alternative approach. This study aimed to evaluate postoperative and oncological results of distal pancreatectomy with and without splenectomy for pancreatic NET.
METHODS
This multicentre retrospective study included all distal pancreatectomy for pancreatic NET performed between 2014 and 2018. Patients with functional NET or multiple endocrine neoplasia type 1 were excluded. Indications and results were compared between DPS, distal pancreatectomy according to Kimura (K-SPDP) and distal pancreatectomy according to Warshaw (W-SPDP), before and after propensity score matching (PSM).
RESULTS
Among 251 patients included (108 DPS (43%), 73 K-SPDP (29%), and 70 W-SPDP (28%)), there was no difference in terms of patients' characteristics, surgical approach, and conversion. Tumour size (P = 0.005), grade (P < 0.001) and the number of nodes analysed (P < 0.001) were significantly lower in patients undergoing K-SPDP as compared to W-SPDP or DPS. Apart from a difference in readmission rate (P = 0.002), there was no difference in terms of mortality rate or severe morbidity rate between the three techniques. After PSM comparing DPS (n = 70) and W-SPDP (n = 70), there was no difference in morbidity and mortality rates. R0 resection rate (91% versus 97%; P = 0.165), the number of nodes analysed (8 versus 7; P = 0.495), and median overall survival (P = 0.493) were not different.
CONCLUSION
In cases of distal pancreatectomy for NET, splenectomy did not seem to improve lymph node dissection or survival. When lymph node dissection associated with distal pancreatectomy is justified, the benefit of splenectomy appears questionable.
背景
远端胰腺切除术常用于左侧胰腺神经内分泌肿瘤（NET）。当需要联合淋巴结清扫时，一般主张行远端胰腺切除术加脾切除术（DPS）以优化淋巴结清扫。保留脾脏的远端胰腺切除术（SPDP）可能是另一种方法。本研究旨在评估行或不行脾切除术的胰腺NET远端胰腺切除术的术后及肿瘤学结果。
方法
这项多中心回顾性研究纳入了2014年至2018年间所有因胰腺NET行远端胰腺切除术的患者。排除功能性NET或1型多发性内分泌肿瘤患者。在倾向评分匹配（PSM）前后，比较DPS、木村式远端胰腺切除术（K-SPDP）和沃肖式远端胰腺切除术（W-SPDP）的适应证及结果。
结果
纳入的251例患者中（108例行DPS（43%），73例行K-SPDP（29%），70例行W-SPDP（28%）），患者特征、手术方式及中转情况方面无差异。与W-SPDP或DPS相比，接受K-SPDP的患者肿瘤大小（P = 0.005）、分级（P < 0.001）及分析的淋巴结数量（P < 0.001）显著更低。除再入院率有差异（P = 0.002）外，三种技术在死亡率或严重并发症发生率方面无差异。PSM比较DPS（n = 70）和W-SPDP（n = 70）后，发病率和死亡率无差异。R0切除率（91%对97%；P = 0.165）、分析的淋巴结数量（8对7；P = 0.495）及中位总生存期（P = 0.493）无差异。
结论
在胰腺NET行远端胰腺切除术的病例中，脾切除术似乎并未改善淋巴结清扫或生存情况。当远端胰腺切除术联合淋巴结清扫合理时，脾切除术的益处似乎存疑。
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