J Gynecol Oncol.  2016 Nov;27(6):e62. 10.3802/jgo.2016.27.e62.

Distal pancreatectomy with splenectomy for the management of splenic hilum metastasis in cytoreductive surgery of epithelial ovarian cancer

• Xiang L
• Tu Y
• He T
• Shen X
• Li Z
• Wu X
• Yang H

• KMID: 2374264
• DOI: http://doi.org/10.3802/jgo.2016.27.e62

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.
CONCLUSION
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.

Keyword

Cytoreductive Surgery; Distal Pancreatectomy; Morbidity; Ovarian Epithelial Cancer; Splenectomy; Treatment Outcome

MeSH Terms

Adult
Aged
*Cytoreduction Surgical Procedures
Disease-Free Survival
Female
Humans
Middle Aged
Neoplasms, Glandular and Epithelial/mortality/pathology/*surgery
Ovarian Neoplasms/mortality/pathology/*surgery
*Pancreatectomy/adverse effects
Postoperative Complications/epidemiology/therapy
*Splenectomy/adverse effects
Splenic Neoplasms/pathology/*secondary/*surgery