Splenic Vein Thrombosis Is Associated with an Increase in Pancreas-Specific Complications and Reduced Survival in Patients Undergoing Distal Pancreatectomy for Pancreatic Exocrine Cancer

Abstract

Distal pancreatectomy and splenectomy (DPS) is the procedure of choice for the surgical treatment of pancreatic exocrine cancer localized to the body and tail of the pancreas. Splenic vein thrombosis (SVT) can occur in patients with malignant pancreatic exocrine tumors secondary to direct tumor invasion or compression of the splenic vein by mass effect. This study examines the effect of preoperative SVT on postoperative outcomes. In this retrospective cohort study, we queried our pancreatic surgery database to identify patients who underwent DPS from October 2005 to June 2011. These cases were evaluated for evidence of preoperative SVT on clinical records and cross-sectional imaging (CT,MRI, endoscopic US). Outcomes for patients with and without SVT were compared. From an overall cohort of 285 consecutive patients who underwent DPS during the study period, data were evaluated for 70 subjects who underwent surgery for pancreatic exocrine cancer (27 with SVT, 43 without SVT). The preoperative demographics and co-morbidities were similar between the groups, except the average age was higher for those without SVT (p<0.05). The median estimated blood loss was significantly higher in the SVT group (675 versus 250 ml, p=<0.001).While the overall morbidity rates were similar between the two groups (48 % SVT versus 56% no SVT, p=NS), the group with SVT had a significantly higher rate of pancreas-specific complications, including pancreatic fistula (33 versus 7 %,p<0.01) and delayed gastric emptying (15 versus 0%, p<0.02). Hospital readmission rates were similar between the groups(30 versus 28 %, p=NS). Patients without SVT had a trend toward longer median survival (40 versus 20.8 months),although the difference was not statistically significant (p=0.1). DPS for pancreatic ductal adenocarcinoma can be performed safely in patients with SVT, but with higher intraoperative blood loss, increased pancreas-specific complications, and a trend towards lower long-term survival rates. This paper was presented as a poster at the 53rd annual meeting of the Society for Surgery of the Alimentary Tract and at the 46th annual meeting of the Pancreas Club, San Diego, CA, May 2012.

Visceral Thromboses in Pancreas Adenocarcinoma: Systematic Review

“…There were no randomized controlled studies. Table 2 shows the characteristics of the included studies; five studies were case reports (70-74), and seven were retrospective studies (14,35,68,69,75-77). All articles, were published after 2007 and were published in the English language.…”

“…PDAC was identified in 19 patients (70%). In this study the authors concluded that SVT was correlated with higher rates of intraoperative blood loss, pancreas-specific complications and reduced long term survival rate (35). This highlights the significance of SVT in the preoperative evaluation of patients with PDAC as well as the potentially increased risk of associated intraoperative complications.…”

“…It is associated with the posterior surface of the tail and body of the pancreas from the hilum of the spleen to its junction with the superior mesenteric vein, where it forms the portal vein(33). It was originally described as a cause of gastrointestinal bleeding (GIB) (32), but it was later observed to be a frequent thrombosis site owing to: its close vicinity to the pancreas (33), inflammation from pancreatitis (34), direct tumor invasion or compression (35) and as consequence of direct trauma and pseudocyst formation(33).…”

Role and Operative Technique of Portal Venous Tumor Thrombectomy in Patients with Pancreatic Neuroendocrine Tumors

“…18 Furthermore, bland and tumor thrombosis of the splenic vein has been reported to be associated with higher rates of intraoperative blood loss, complications from surgery, and possibly, a shorter long-term survival following primary tumor resection. 19 It should be emphasized that although the techniques of thrombectomy we described here may be appropriate in some cases of pNET which involve the portal venous system, these cases must be well selected. Three important considerations are noteworthy in this regard.…”

Pancreatic neuroendocrine tumor with splenic vein tumor thrombus: A case report

“…In a comparison of patients with pancreatic adenocarcinoma who underwent distal pancreatectomy and splenectomy, Dedania and colleagues found that those who had a splenic vein thrombus were more likely to have pancreas-specific complications including pancreatic fistulas and delayed gastric emptying; the median survival, however, was not significantly different compared to patients who did not have a splenic vein thrombus. 12 …”