title: Splenic artery invasion in pancreatic adenocarcinoma of the body and tail: a novel prognostic parameter for patient selection.
abstract: BACKGROUND
  The value of splenic vessels invasion (which identified T3 tumors) in prognosis after resection for pancreatic ductal adenocarcinoma (PDA) of the body and tail has not been extensively investigated. The goal of this study was to evaluate prognostic factors in PDA of the body/tail, emphasizing the role of splenic vessels infiltration.
  
  
  METHODS
  Between 1990 and 2008, 87 patients who underwent distal pancreatectomy (DP) for histologically proven PDA of the body and tail were analyzed. Clinicopathological prognostic factors for survival were evaluated. Univariate and multivariable analyses were performed.
  
  
  RESULTS
  Postoperative morbidity was 31% with no mortality. The 1-, 3-, and 5-year overall survival rates were 77%, 48%, and 24.5%, respectively. Invasion of the splenic artery (SA) was observed in 19 patients (22%). Patients with SA invasion had a significantly poorer prognosis compared with those without SA invasion (median survival: 15 vs. 39 months, P = 0.014). On multivariable analysis, adjuvant therapy, poor differentiation (G3/G4), R2 resection, the presence of lymph node metastases, and SA invasion were independent predictors of survival.
  
  
  CONCLUSIONS
  Along with other well-known prognostic factors, invasion of SA is an independent predictor of poor survival in PDA of the body/tail. In case of the presence of SA infiltration, neoadjuvant treatment should be considered. SA infiltration might be reclassified from a T3 to T4 tumor.
authors.affiliation: Department of Surgery, University of Verona, Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Partelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Crippa
authors.forename: Giuliano
authors.initials: G
authors.lastname: Barugola
authors.forename: Domenico
authors.initials: D
authors.lastname: Tamburrino
authors.forename: Paola
authors.initials: P
authors.lastname: Capelli
authors.forename: Mirko
authors.initials: M
authors.lastname: D'Onofrio
authors.forename: Paolo
authors.initials: P
authors.lastname: Pederzoli
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D013157:Splenic Artery / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate