The impact of splenectomy on outcomes after resection of pancreatic adenocarcinoma

Background: Splenectomy at the time of resection of esophageal, gastric, or colon cancer has been correlated with inferior longterm survival. Na such effect has yet been demonstrated for pancreatic cancer. Study Design: patients undergoing resection of pancreatic adenocarcinoma wi th curative intent at Memorial Sloan-Kettering Cancer Center between Octobe r 1983 and October 1995 were identified from a prospective clinical databas e. The impact of splenectomy on hospital stay and survival was calculated w ith univariate and multivariate nonparametric methods. Results: Of 332 patients undergoing pancreatectomy, 326 with confirmed Loca l or regional disease only formed the study cohort. Of these, 37 underwent concomitant splenectomy (11.4%). Splenectomy was significantly correlated w ith distal or total pancreatectomy, primary location in tail or body, porta l vein invasion or resection, a larger maximal tumor diameter, and an opera tive blood loss of greater than 2,000 mL. Death or need for reoperation was not affected by splenectomy. patients undergoing splenectomy had a higher median transfusion requirement (3 versus 1; p = 0.002). The median postoper ative length of stay was 15 days regardless of splenectomy. At a median fol lowup of 16.3 months (36.4 months for surviving patients), the median actua rial survival was 12.2 months with splenectomy versus 17.8 months without s plenectomy (p < 0.005). On multivariate analysis, splenectomy emerged as an independent factor predictive of decreased postoperative survival (p = 0.0 2), in addition to pathologic lymph node status (p = 0.0002), tumor diamete r (p = 0.0004), and tumor differentiation (p = 0.007). Tumor location withi n the pancreas and the type of pancreatectomy were not independent prognost ic factors influencing survival. Conclusions: After pancreatectomy for pancreatic cancer, splenectomy has no significant measurable impact on postoperative recovery, but has a negativ e influence on longterm survival independent of disease-related factors. Un less required because of tumor proximity or invasion, splenectomy should be avoided in the operative treatment of exocrine pancreatic cancer at any lo cation. (J Am Coll Surg 1999;188:516-521. (C) 1999 by the American College of Surgeons).