Dynamic hematological changes in patients undergoing distal pancreatectomy with or without splenectomy: a population-based cohort study

Abstract

Background The clinical outcomes of patients who received distal pancreatectomy with splenectomy (DPS) and spleen-preserving distal pancreatectomy (SPDP) have been generally investigated. However, postoperative hematological changes after distal pancreatectomy with or without splenectomy are poorly understood. Methods Information from patients undergoing distal pancreatectomy (DP) between January 2014 and June 2019 at a single institution was reviewed. A linear mixed-effects model was used to compare dynamic hematological changes between different groups. Results A total of 302 patients who underwent DP were enrolled. In the long term, most postoperative hematological parameters remained significantly higher than preoperative levels in the DPS group, while postoperative lymphocyte, monocyte, basophil, and platelet levels returned to preoperative levels in the SPDP group. All postoperative hematological parameters except for red blood cell count and serum hemoglobulin level were significantly higher in the DPS group than in the SPDP group. There were no significant differences in hematological changes between the splenic vessel preservation (SVP) and Warshaw technique (WT) groups. Conclusions Postoperative hematological changes were significantly different between the DPS and SPDP groups. Compared to DPS, SPDP reduced abnormal hematological changes caused by splenectomy. SVP and WT were comparable in terms of postoperative hematological changes.

Negative prognostic implications of splenomegaly in nivolumab-treated advanced or recurrent pancreatic adenocarcinoma

“…In patients with pancreatic neoplasms who received distal pancreatectomy and splenectomy, peripheral blood lymphocyte count recovered gradually and even exceeded the preoperative level 2 weeks after the operation. 42 By contrast, patients with preserved spleens had lymphocyte counts comparable to the baseline. 42 Splenomegaly and lymphopenia may be directly or indirectly implicated in the efficacy of nivolumab.…”

“… 42 By contrast, patients with preserved spleens had lymphocyte counts comparable to the baseline. 42 Splenomegaly and lymphopenia may be directly or indirectly implicated in the efficacy of nivolumab. First, skewed expansion of myeloid cells in the spleen or TME may suppress T-cell proliferation or induce lymphopenia through multiple pathways in addition to the PD-1/PD-L1 axis.…”

A retrospective, multicentric, nationwide analysis of the impact of splenectomy on survival of pancreatic cancer patients

“…In the splenectomy group, they additionally observed a lower ratio of effector T cells (CD8+/CD4+) to immunosuppressive regulatory T cells (FOXP3+), suggesting an impaired anti-tumor immune response 12 . Also in the human organism hematological changes can be observed after splenectomy 20 . However, in our data we only observed a survival difference in the total pancreatectomy group but not in the distal pancreatectomy group.…”