30 | wetenschapsdag 2023 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen x6 Auteurs C. L Bruna, J. van Hilst, A. Esposito, D. Kleive, M. Falconi, J.N. Primrose, M. Korrel, A. Zerbi, A. Kokkola, G. Butturini, B. Björnsson, R. Casadei, R. Marudanayagam, M.G. Besselink, M. Abu Hilal* Abstract titel Histopathological appraisal of splenic hilum lymphadenectomy during distal pancreatectomy for pancreatic cancer: predefined subanalysis of the DIPLOMA trial Background Splenectomy during distal pancreatectomy is considered to be standard in the surgical management of resectable left-sided pancreatic ductal adenocarcinoma (PDAC). This is justified by the need to obtain a complete lymphadenectomy. However, scientific evidence supporting this approach is still lacking. We aim to perform the appraisal of splenic hilum lymph node involvement in distal pancreatectomy specimens examined in the DIPLOMA trial using standardized pathology procedures. Methods The international randomized patient- and pathologist-blinded DIPLOMA-trial enrolled 258 patients with resectable pancreatic body and tail cancer between minimally invasive and open distal pancreatectomy (May 8, 2018 - May 7, 2021), of which patients with PDAC were included in the present predefined subanalysis. The primary outcome was the number of identified and positive lymph nodes (LNs) in the splenic hilum. The secondary outcome was survival in patients with and without splenic hilum LN metastasis. Cox regression analyses were performed to determine whether splenic LN metastasis predict survival. Results In total, 185 patients were included in the present analysis. Medium number of identified LNs was 23.0 (IQR 15.0–32.0) , and median number of identified LNs in the splenic hilum was 3.0 (IQR 1.0-6.0). Notably, only four patients (4/185; 2.2%) had splenic hilum LN metastasis, of whom three patients had pancreatic tail cancer and one patient had pancreatic body cancer. Of these, three patients also had LN metastases superior and inferior of the pancreas. Median survival of four patients with splenic hilum LN metastasis was 17 months [range 13-36]. Median survival in patients without splenic hilum LN metastasis was not reached (30-months survival rate 60%) (p = 0.714). Upon Cox regression analysis, the small number of patients with splenic hilum LN metastasis prevents a firm conclusion on its role as an independent predictor of survival.
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