{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T11:07:46Z","timestamp":1789124866980,"version":"build-2803163510"},"reference-count":60,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Splenectomy is standard of care during left pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) to obtain adequate lymphadenectomy. However, evidence supporting this approach is lacking. Splenic preservation would reduce short-term morbidity and is essential for emerging oncological adjunctive therapies, including immunotherapy and personalized cancer vaccines. This study reviewed the incidence of splenic hilum nodal involvement (SHNI) in left-sided PDAC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review of the PubMed, Embase, and Cochrane databases was performed, identifying studies published from inception to July 2026. Outcomes of interest were the rate of SHNI (station 10), overall survival, and the rate of splenic artery nodal involvement (SANI; station 11). Meta-analyses were conducted using random-effects models. Subgroup analyses for SHNI were performed per tumour localization (pancreatic neck, body, tail).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2776 screened studies, 22 with 2260 patients undergoing left pancreatectomy for PDAC were included. The pooled prevalence of SHNI was 3.7% (95% confidence interval (c.i.) 2.2% to 6.2%); 1.1% for pancreatic body PDAC (95% c.i. 0.3% to 4.3%) and 9.7% for pancreatic tail PDAC (95% c.i. 3.5% to 24.0%). SHNI was not significantly associated with survival (pooled hazard ratio 2.05; 95% c.i. 0.89% to 4.72; P = 0.072). The pooled prevalence of SANI was 39.1% (95% c.i. 25.1% to 55.1%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients undergoing left pancreatectomy for PDAC, the presence of SHNI is rare, particularly in pancreatic body cancer (1.1%). These findings suggest that the relevance of routine splenectomy remains unclear, especially for pancreatic body PDAC. However, because the quality of current evidence is low, further investigation in prospective studies is required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag153","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:48:03Z","timestamp":1785498483000},"source":"Crossref","is-referenced-by-count":0,"title":["Splenic hilum nodal involvement in resected left-sided pancreatic cancer: meta-analysis"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9556-1308","authenticated-orcid":false,"given":"Caro L","family":"Bruna","sequence":"first","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte E","family":"Baggerman van Houweninge","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faridi S","family":"Jamaludin","sequence":"additional","affiliation":[{"name":"Medical Library, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiseppe","family":"Malleo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Verona University Hospital , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Abu Hilal","sequence":"additional","affiliation":[{"name":"Department of Surgery, The University of Jordan, School of Medicine , Amman ,","place":["Jordan"]},{"name":"Department of Surgery, University Hospital Southampton NHS Foundation Trust , Southampton ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2650-9350","authenticated-orcid":false,"given":"Marc G","family":"Besselink","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4990-445X","authenticated-orcid":false,"given":"Jony","family":"van Hilst","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Department of Surgery, OLVG Hospital , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"2026091106240656600_zrag153-B1","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.surg.2014.06.016","article-title":"Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS)","volume":"156","author":"Tol","year":"2014","journal-title":"Surgery"},{"key":"2026091106240656600_zrag153-B2","doi-asserted-by":"crossref","first-page":"znae039","DOI":"10.1093\/bjs\/znae039","article-title":"Standardizing definitions and terminology of left-sided pancreatic resections through an international Delphi consensus","volume":"111","author":"van Ramshorst","year":"2024","journal-title":"Br J Surg"},{"key":"2026091106240656600_zrag153-B3","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/s00534-012-0549-z","article-title":"Proposal for splenectomy-omitting radical distal pancreatectomy in well-selected left-sided pancreatic cancer: multicenter survey study","volume":"20","author":"Kim","year":"2013","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"2026091106240656600_zrag153-B4","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1016\/j.ejso.2020.04.006","article-title":"Reappraisal of nodal staging and study of lymph node station involvement in distal pancreatectomy for body\u2013tail pancreatic ductal adenocarcinoma","volume":"46","author":"Malleo","year":"2020","journal-title":"Eur J Surg Oncol"},{"key":"2026091106240656600_zrag153-B5","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1016\/j.hpb.2020.01.016","article-title":"Distal pancreatectomy for pancreatic neoplasia: is splenectomy really necessary? 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