Splenic Artery Invasion in Pancreatic Adenocarcinoma of the Body and Tail: A Novel Prognostic Parameter for Patient Selection
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The value of splenic vessels invasion (which identified T3 tumors) in prognosis after resection for pancreatic ductal adenocarcinoma (PDA) of the body and tail has not been extensively investigated. The goal of this study was to evaluate prognostic factors in PDA of the body/tail, emphasizing the role of splenic vessels infiltration.
Between 1990 and 2008, 87 patients who underwent distal pancreatectomy (DP) for histologically proven PDA of the body and tail were analyzed. Clinicopathological prognostic factors for survival were evaluated. Univariate and multivariable analyses were performed.
Postoperative morbidity was 31% with no mortality. The 1-, 3-, and 5-year overall survival rates were 77%, 48%, and 24.5%, respectively. Invasion of the splenic artery (SA) was observed in 19 patients (22%). Patients with SA invasion had a significantly poorer prognosis compared with those without SA invasion (median survival: 15 vs. 39 months, P = 0.014). On multivariable analysis, adjuvant therapy, poor differentiation (G3/G4), R2 resection, the presence of lymph node metastases, and SA invasion were independent predictors of survival.
Along with other well-known prognostic factors, invasion of SA is an independent predictor of poor survival in PDA of the body/tail. In case of the presence of SA infiltration, neoadjuvant treatment should be considered. SA infiltration might be reclassified from a T3 to T4 tumor.
KeywordsDistal Pancreatectomy Splenic Artery Pancreatic Ductal Adenocarcinoma Splenic Vein Splenic Vessel
The authors thank Ms. Deborah McGrath for help with revising the manuscript.
Conflicts of interest
There are no conflicts of interest to declare.
- 15.Sobin LH, Gospodarowicz MK, Wittekind C. UICC: TNM classification of malignant tumors, 7th edn. Oxford: Wiley-Blackwell; 2009.Google Scholar
- 17.Lu DS, Reber HA, Krasny RM, Kadell BM, Sayre J. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. Am J Roentgenol. 1997;168(6):1439–43.Google Scholar
- 18.Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M; International Study Group on Pancreatic Fistola Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.PubMedCrossRefGoogle Scholar
- 24.Japan Pancreatic Society. Classification of pancreatic carcinoma, 6th edn. Tokyo: Kanehara; 2009.Google Scholar