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Published on: December 20, 2024
796
Spleen Preservation in Solid Pseudopapillary Neoplasms: Evidence, Rationale, and Practical Considerations.
M C Lenzi1, M C A P Carvalho2, G F S Rocha3
1School of Medicine, Universidade Do Estado Do Rio Grande Do Norte (UERN), Mossoró, Brazil.
The American Surgeon
|December 8, 2025
Summary
Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) offers comparable short-term outcomes to spleen-removing surgery for solid pseudopapillary neoplasms (SPNs). Given SPNs' low malignancy and the benefits of spleen preservation, LSPDP is recommended when feasible.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Pancreatic Surgery
Background:
- Solid pseudopapillary neoplasms (SPNs) predominantly affect young women.
- Distal pancreatic tumors present a surgical dilemma: splenectomy versus spleen preservation.
- The oncologic necessity of splenectomy conflicts with the long-term immunologic benefits of spleen preservation.
Purpose of the Study:
- To systematically review and compare laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with laparoscopic distal pancreatectomy with splenectomy (LSDP) for SPN.
- To synthesize current evidence to guide clinical decision-making for surgical management of SPNs.
Main Methods:
- Systematic review and meta-analysis of retrospective studies.
- Comparison of LSPDP versus LSDP for SPN.
- Inclusion of 3 studies with a total of 96 patients.
Main Results:
- Comparable perioperative morbidity between LSPDP and LSDP.
- No significant differences in overall complications, pancreatic fistula, or severe complications.
- LSDP had a significantly shorter operative time; a trend towards higher lymph node yield was observed in the LSDP group.
Conclusions:
- LSPDP is a safe and feasible option for selected SPN patients, with comparable short-term morbidity to LSDP.
- Considering the low malignant potential of SPNs and the lifelong immunologic benefits of splenic function, LSPDP is the preferred approach when oncologically and technically feasible.
- This review provides a framework for surgical decision-making in the management of rare pancreatic tumors like SPNs.
