Spleen Preservation in Solid Pseudopapillary Neoplasms: Evidence, Rationale, and Practical Considerations

Solid pseudopapillary neoplasms (SPNs) of the pancreas primarily affect young women, placing the surgical decision for distal tumors at a clinical crossroads: the oncologic necessity of splenectomy vs the long-term immunologic benefit of spleen preservation. This study synthesizes the current evidence to guide clinical practice. We conducted a systematic review and meta-analysis comparing laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with laparoscopic distal pancreatectomy with splenectomy (LSDP) for SPN, identifying 3 retrospective studies (n = 96 patients). The evidence base, though limited, showed comparable perioperative morbidity. No significant differences were found in overall complications (OR = 0.73; 95% CI: 0.23 to 2.31; P = 0.60), postoperative pancreatic fistula (OR = 0.51; 95% CI: 0.09 to 2.92; P = 0.45), or severe complications (OR = 0.32; 95% CI: 0.05 to 1.96; P = 0.22). Laparoscopic distal pancreatectomy with splenectomy was associated with a significantly shorter operative time (MD = -63.49 min; 95% CI: -123.79 to -3.18; P = 0.04). A non-significant trend toward a higher lymph node yield was observed in the LSDP group (MD = +4.29; 95% CI: -0.29 to 8.86; P = 0.07). The available evidence suggests LSPDP is a safe and feasible option in selected patients, achieving comparable short-term morbidity to LSDP. Given the low malignant potential of SPNs and the lifelong immunologic benefits of splenic function, especially in the typical young patient demographic, LSPDP should be the preferred approach when oncologically and technically feasible. This review provides a practical framework for surgical decision making in this rare tumor.