title: A review of splenic pathology in distal pancreatectomies.
abstract: OBJECTIVE
  Splenectomy is often performed during distal pancreatectomy for malignancy, yet little data exist demonstrating splenic involvement in distal pancreatic pathology.
  
  
  METHODS
  We retrospectively reviewed 81 distal pancreatectomies performed for suspected or known pancreatic malignancies from 6/1/05 to 7/6/11. Exclusion criteria included metastatic disease, previous splenic preserving distal pancreatectomy, or planned en-bloc resection, leaving 47 cases. Data collected included spleen, hilar lymph node, or splenic vessel involvement by malignancy as confirmed by final pathology report. This was correlated with preoperative computed tomography (CT).
  
  
  RESULTS
  Final pathology showed adenocarcinoma in 10 (21%) patients. Three patients with adenocarcinoma had invasion of the spleen, splenic vessels or nodes on pathology. The first involved the splenic flexure, necessitating en-bloc colon resection. The second had splenic artery involvement as identified by CT, but no malignancy within the spleen. The third had direct extension to one of 11 peri-splenic nodes with significant inflammatory reaction noted intraoperatively.
  
  
  CONCLUSIONS
  Splenectomy is not mandated for all distal pancreatic tumors, and the spleen can be preserved in an overwhelming majority of cases. Pre- and intraoperative factors can adequately identify the necessity of splenectomy, and the approach should be tailored to individual patients.
authors.affiliation: Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency, Grand Rapids, MI, USA. Electronic address: Jill.Onesti@grmep.com.
authors.forename: Jill K
authors.initials: JK
authors.lastname: Onesti
authors.forename: Mathew H
authors.initials: MH
authors.lastname: Chung
authors.forename: Deepali H
authors.initials: DH
authors.lastname: Jain
authors.forename: Misty M
authors.initials: MM
authors.lastname: Stafford
authors.forename: Payal P
authors.initials: PP
authors.lastname: Attawala
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects; D010190:Pancreatic Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D013154:Spleen / Q000473:pathology*; D013156:Splenectomy; D013158:Splenic Diseases / Q000209:etiology / Q000473:pathology; D013160:Splenic Neoplasms / Q000473:pathology / Q000556:secondary; D014057:Tomography, X-Ray Computed
keywords: Distal pancreatectomy; Spleen preserving; Splenectomy