Laparoscopic Spleen Preservation Versus Splenectomy For Frantz Tumors: A Systematic Review And Meta-analysis On Perioperative And Oncological Outcomes

Introduction : Solid pseudopapillary neoplasms (SPNs), or Frantz tumors, are rare borderline epithelial neoplasms of the pancreas. There is no consensus regarding spleen management in SPNs, and distal pancreatectomy is the standard treatment for body and tail tumors. However, whether spleen-preserving distal pancreatectomy (SPDP) or distal pancreatectomy with splenectomy (SDP) provides better oncological and perioperative outcomes remains uncertain. Methods: We systematically searched Embase, Cochrane, and PubMed databases for studies comparing SPDP and SDP in SPN patients, focusing on overall complications as the main outcome. A random-effects model was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Results: Out of 290 screened articles, five studies met the inclusion criteria, comprising 40 patients who underwent SDP and 23 who underwent SPDP. Meta-analysis showed no significant difference in overall complication rates (OR = 0.55,95% CI: 0.16-1.93, p = 0.35, I² = 0%) or pancreatic fistula incidence (OR = 0.32, 95% CI: 0.06-1.77, p = 0.19). Notably, both techniques demonstrated equivalent oncological outcomes, with no reported recurrence or mortality in either group during long-term follow-up, ranging from a mean of 7.9 to 47 months. Conclusion: SPDP and SDP are equally safe surgeries with similar oncological results, and therefore, choosing between the two should be based on technical feasibility and patient factors rather than oncological concerns