Effects of distal pancreatectomy and splenectomy on outcomes in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with CC/0 resection

Background and Aims: This study aims to determine the early and late postoperative effects of distal pancreatectomy plus splenectomy in patients who underwent cytoreductive surgery and hyperthermic intra- peritoneal chemotherapy and achieved CC0 resection due to peritoneal carcinomatosis. Materials and Method: All patients who underwent a cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure due to peritoneal carcinomatosis of various tumors in our clinic between 2014 and 2020 were included in the study. Data from all patients who underwent additional distal pancreatectomy plus splenec- tomy were analyzed retrospectively. Results: The cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure with CC/0 resection was performed on 85 of 136 patients diagnosed with peritoneal carcinomatosis. Of these patients, 13 (15.3%) had undergone distal pancreatectomy plus splenectomy together with the main procedure. The mean hospital stay was 15 (range, 5–50) days in patients who underwent distal pancreatectomy plus splenectomy, whereas it was 13 (range, 4–109) days in those who did not, and the difference was statistically insignificant. The most common major complications seen in the distal pancreatectomy plus splenectomy group were an anastomotic leak, enterocutaneous fistula, and intraabdominal abscess. The 30-day mortality was two (15.38%) and one (1.38%) in the group with and the group without distal pancreatectomy plus splenectomy, respectively. When the groups were evaluated, the median survival time was 19 months in the cytoreductive surgery and hyperthermic intraperitoneal chemotherapy group and 18 months in the cytoreductive surgery and hyperthermic intraperitoneal chemotherapy + distal pancreatectomy plus splenectomy group. This difference was statistically insignificant (p = 0.382). Conclusion: The addition of distal pancreatectomy plus splenectomy increased major postoperative complications in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy but did not affect overall survival. We think distal pancreatectomy plus splenectomy can be performed for a complete cytoreduction if necessary. However, it increases major postoperative complications, and patient follow-up should be done accordingly.