Background : Radical antegrade modular pancreatosplenectomy (RAMPS) is developed for left-sided pancreatic cancer, with advantage of negative margin and extensive lymph node (LN) retrieval. While splenectomy is typically performed for extensive splenic hilar LN dissection in left-sided pancreatic cancer, limited study has reported the impact on oncologic long-term outcomes when splenectomy is omitted.

Methods : From 2008 to 2020, 255 patients underwent distal pancreatectomy for left-sided pancreatic ductal adenocarcinoma, either with RAMPS (223 patients) or splenectomy-omitting distal pancreatectomy (DP) (32 patients). Comparative analysis included preoperative, tumor-related factors and perioperative outcomes. Overall survival (OS) and disease-free survival (DFS) were compared using Kaplan-Meier method with log-rank test between two groups.

Results : DP was more performed for pancreatic body cancer (75.0% vs. 50.2%, P= 0.009), while RAMPS was more performed for pancreatic tail cancer (15.6% vs. 37.2%, P= 0.016). No significant difference was observed in the rate of negative resection margin (DP 90.6% vs. RAMPS 78.9%, P= 0.388) and the number of retrieved LNs (12.0 vs. 13.2, P= 0.506). Tumor-related factors showed no significant difference between the two groups. Both DP and RAMPS demonstrated similar recurrence rates (75.0% vs. 75.3%, P= 0.967), and local recurrence rate (18.8 vs. 10.3%, P= 0.336) without recurrence at splenic hilum. RAMP did not significantly differ from RAMPS in terms of OS (P= 0.804) and DFS (P= 0.913).

Conclusions : Splenectomy-omitting DP for immunologic advantages, is feasible for left-sided pancreatic cancer and demonstrated non-inferior oncologic long-term outcomes compared to RAMPS, with no local recurrence at the splenic hilum.