title: Distal pancreatectomy with splenectomy for the management of splenic hilum metastasis in cytoreductive surgery of epithelial ovarian cancer.
abstract: OBJECTIVE
  Distal pancreatectomy with splenectomy may be required for optimal cytoreductive surgery in patients with epithelial ovarian cancer (EOC) metastasized to splenic hilum. This study evaluates the morbidity and treatment outcomes of the uncommon procedure in the management of advanced or recurrent EOC.
  
  
  METHODS
  This study recruited 18 patients who underwent distal pancreatectomy with splenectomy during cytoreductive surgery of EOC. Their clinicopathological characteristics and follow-up data were retrospectively analyzed.
  
  
  RESULTS
  All tumors were confirmed as high-grade serous carcinomas. The median diameter of metastatic tumors located in splenic hilum was 3.5 cm (range, 1 to 10 cm). Optimal cytoreduction was achieved in all patients. Eight patients (44.4%) suffered from postoperative complications. The morbidity associated with distal pancreatectomy and splenectomy included pancreatic leakage (22.2%), encapsulated effusion in the left upper quadrant (11.1%), intra-abdominal infection (11.1%), pleural effusion with or without pulmonary atelectasis (11.1%), intestinal obstruction (5.6%), pneumonia (5.6%), postoperative hemorrhage (5.6%), and pancreatic pseudocyst (5.6%). There was no perioperative mortality. The majority of complications were treated successfully with conservative management. During the median follow-up duration of 25 months, nine patients experienced recurrence, and three patients died of the disease. The 2-year progression-free survival and overall survival were 40.2% and 84.8%, respectively.
  
  
  CONCLUSIONS
  The inclusion of distal pancreatectomy with splenectomy as part of cytoreduction for the management of ovarian cancer was associated with high morbidity; however, the majority of complications could be managed with conservative therapy.
authors.affiliation: Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Libing
authors.initials: L
authors.lastname: Xiang
authors.affiliation: Department of Oncology, Maternal and Child Health Hospital of Jiangxi Province, Nanchang, China.
authors.forename: Yunxia
authors.identifier: http://orcid.org/0000-0001-9672-2267
authors.initials: Y
authors.lastname: Tu
authors.affiliation: Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Tiancong
authors.identifier: http://orcid.org/0000-0002-5736-3617
authors.initials: T
authors.lastname: He
authors.affiliation: Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.|Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.
authors.forename: Xuxia
authors.identifier: http://orcid.org/0000-0003-2302-7188
authors.initials: X
authors.lastname: Shen
authors.affiliation: Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Ziting
authors.identifier: http://orcid.org/0000-0003-2993-7369
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Xiaohua
authors.identifier: http://orcid.org/0000-0002-6889-3541
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. huijuanyang@hotmail.com.
authors.forename: Huijuan
authors.identifier: http://orcid.org/0000-0003-4569-6454
authors.initials: H
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D013156:Splenectomy / Q000009:adverse effects; D013160:Splenic Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*
keywords: Cytoreductive Surgery; Distal Pancreatectomy; Morbidity; Ovarian Epithelial Cancer; Splenectomy; Treatment Outcome