Home›Diabetes & Endocrinology› Meta-analysis of splenic-preserving vs splenectomy distal pancreatectomy for resectable body/tail pNETs
Meta-analysis of splenic-preserving vs splenectomy distal pancreatectomy for resectable body/tail pNETsMeta-analysis suggests splenic-preserving surgery may reduce complications for certain pancreatic tumors
Frontiers in MedicinePublished April 16, 2026DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Consider SPDP as a feasible option for selected patients with small, well-differentiated G1/G2 pNETs pending further investigation.
This systematic review and meta-analysis compared splenic-preserving distal pancreatectomy (SPDP) against distal pancreatectomy with splenectomy (DPS) in patients with resectable pancreatic neuroendocrine tumors (pNETs) located in the body or tail of the pancreas. The pooled analysis included 457 patients, comprising 226 with SPDP and 231 with DPS. The study aimed to determine if preserving the spleen offers perioperative advantages without compromising oncologic outcomes.
The meta-analysis demonstrated favorable results for SPDP across several metrics. Intraoperative blood loss was significantly lower with SPDP (SMD, -0.50; 95% CI [-0.90 to -0.11], P = 0.01). The number of lymph nodes examined was fewer with SPDP (MD, -3.30; 95% CI [-5.35 to -1.24], P = 0.002), and operative time was shorter (MD, -31.78 min; 95% CI [-57.98 to -5.58], P = 0.02). Postoperative major complications occurred less frequently with SPDP (OR, 0.57; 95% CI [0.34 to 0.95], P = 0.03), as did transfusion rates (OR, 0.25; 95% CI [0.07 to 0.83], P = 0.02). Hospital stay was also shorter (MD, -1.13 days; 95% CI [-2.02 to -0.24], P = 0.01).
Regarding oncologic safety, the analysis found no significant difference in R0 resection rates (OR, 1.40; 95% CI [0.43 to 4.58], P = 0.58) or lymph node metastasis (OR, 0.95; 95% CI [0.49 to 1.85], P = 0.88). Adverse events, serious adverse events, and discontinuations were not reported. The authors caution that these findings should be interpreted as hypothesis-generating and highlight the need for further investigation. Consequently, SPDP may represent a feasible option for selected patients with small, well-differentiated G1/G2 pNETs, though practice relevance remains to be fully established.
This systematic review and meta-analysis examined surgical outcomes for patients with resectable pancreatic neuroendocrine tumors located in the body or tail of the pancreas. The analysis combined data from 457 patients who underwent either a splenic-preserving distal pancreatectomy (SPDP) or a distal pancreatectomy with splenectomy (DPS). The goal was to determine if keeping the spleen offered better results than removing it.
The researchers found that SPDP was associated with significantly less blood loss during surgery and a shorter time in the operating room. Patients who had their spleen preserved also experienced lower rates of needing blood transfusions, fewer major postoperative complications, and a shorter hospital stay. In contrast, the number of lymph nodes examined and the rates of cancer spread or incomplete tumor removal did not differ significantly between the two groups.
No specific adverse events or safety concerns were reported in the available data. The authors note that these findings should be interpreted as hypothesis-generating. Because the study is a meta-analysis of existing reports rather than a single new trial, more research is needed to confirm these results. Readers should understand that SPDP may be a feasible option for selected patients, but it is not yet proven as a standard replacement for removing the spleen.
What this means for you:
Meta-analysis suggests splenic-preserving surgery may reduce complications for certain pancreatic tumors, but more research is needed.
BackgroundFor resectable pancreatic neuroendocrine tumors (pNETs) located in the body or tail of pancreas that require surgery, distal pancreatectomy with splenectomy (DPS) is standard. While splenic-preserving distal pancreatectomy (SPDP) may reduce complications and provide additional benefits, its feasibility in pNETs remains uncertain. This study compares the perioperative outcomes of SPDP versus DPS for pNET patients.MethodsA comprehensive literature search was conducted in PubMed, Embase, and Web of Science included studies published before June 1, 2025. The analysis focused on primary endpoints of intraoperative blood loss (ml) and lymph nodes harvested, as well as secondary endpoints including operative time (min), transfusion, R0 resection, postoperative major complications (PMCs), postoperative pancreatic fistula (POPF), postoperative hemorrhage (PPH), hospital stay (day), lymph node metastasis (LNM), and reintervention. The pooled analysis is presented as odds ratios (OR) or mean differences (MD) with 95% confidence interval (CI). The protocol is registered on PROSPERO (CRD420251079167).Results4 retrospective studies involving 457 patients (226 with SPDP and 231 with DPS) were analyzed. 401 patients have well-differentiated G1/G2 tumors, and the majority of SPDP patients have small tumors. Compared to DPS, SPDP had less intraoperative blood loss (SMD, -0.50, 95% CI [-0.90 to -0.11], P = 0.01), fewer lymph nodes examined (MD, -3.30, 95% CI [-5.35 to -1.24], P = 0.002), shorter operative time (MD, -31.78 min, 95% CI [-57.98 to -5.58], P = 0.02), fewer PMCs (OR, 0.57, 95% CI [0.34 to 0.95], P = 0.03) and lower transfusion rates (OR, 0.25, 95% CI [0.07 to 0.83], P = 0.02). In terms of length of hospital stay, SPDP demonstrated more favorable outcomes (MD, −1.13 days, 95% CI [−2.02 to −0.24], P = 0.01). No significant differences were observed regarding R0 resection (OR, 1.40, 95% CI [0.43 to 4.58], P = 0.58), LNM (OR, 0.95, 95% CI [0.49 to 1.85], P = 0.88), or other perioperative outcomes.ConclusionThis study proposes that SPDP may represent a feasible option for selected patients with small, well-differentiated G1/G2 pNETs, suggesting a potential role in reducing surgical risks. These findings should be interpreted as hypothesis-generating, highlighting the need for further investigation.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/recorddashboard, identifier CRD420251079167.
