EXTENDED LEFT PANCREATECTOMY: POSTOPERATIVE AND SHORT-TERM ONCOLOGIC OUTCOMES. A PROSPECTIVE STUDY (SPANDISPAN PROJECT)

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ABSTRACT Background Extended left pancreatectomy (ELP) reflects locally advanced disease requiring multivisceral resection, yet evidence on its perioperative safety and early oncologic outcomes remains limited and heterogeneous. We aimed to determine the proportion of ELP among distal pancreatectomies and to compare short-term postoperative outcomes and early recurrence rates between ELP and standard left pancreatectomy (SLP). Methods We conducted a prospective, multicenter, observational snapshot study including consecutive patients undergoing left pancreatectomy in Spanish hepatopancreatobiliary units over 1 year (February 1, 2022–February 28, 2023). ELP was defined according to ISGPS criteria (standard left pancreatectomy plus resection of adjacent organs/major vascular structures). Outcomes included intraoperative variables, 90-day morbidity (Clavien–Dindo), clinically relevant postoperative pancreatic fistula (POPF), length of stay, textbook outcome, and recurrence within 90 days. In the ELP cohort, predictors of early recurrence were explored using logistic regression. Results Among 313 patients, 42 (13.4%) underwent ELP. Compared with SLP (n=271), ELP was less frequently performed by a minimally invasive approach (42.9% vs. 73.4%, p<0.001), had longer operative time (median 270 vs. 240 min, p=0.012), and higher blood loss (median 200 vs. 100 mL, p=0.014). Overall complications (61.9% vs. 57.2%, p=0.565), major complications (26.2% vs. 20.3%, p=0.383), and POPF grade B/C (19% vs. 20.3%, p=0.851) were similar. In-hospital mortality was significantly higher after ELP (4.8% vs. 0.4%, p=0.048), as was length of stay (8 vs. 7 days, p=0.031), while textbook outcome was lower (38.1% vs. 58.3%, p=0.014). ELP was associated with higher malignancy rates (88.1% vs. 62.7%, p=0.001) and higher recurrence (26.2% vs. 5.2%, p<0.001). Among the 207 patients with malignant histology, exploratory multivariable analysis identified surgical conversion (OR 12.74, p=0.020) and resection of additional organs other than the spleen (OR 6.42, p=0.045) as independent correlates of early recurrence; because preoperative CA 19-9, neoadjuvant therapy, and neuroendocrine tumor grading were not collected, these findings cannot establish whether conversion and organ resection reflect tumor biology or unmeasured preoperative understaging, and should be regarded as hypothesis-generating. Conclusion ELP increases technical complexity and in-hospital mortality but does not significantly worsen major morbidity or clinically relevant POPF. Early recurrence was substantially higher after ELP and was independently associated, in exploratory analysis, with surgical conversion and multiorgan resection extent; whether these predictors reflect locally advanced tumor biology or unmeasured preoperative understaging could not be determined with the available data and requires dedicated prospective validation.

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