Does the type of neoplasm influence the development of postoperative complications following distal pancreatectomy? A multicenter prospective snapshot study from the Spanish distal pancreatectomy project (SPANDISPAN)

Introduction: The morbidity associated with left pancreatectomy (LP) is estimated at 20-25 % for major complications, with a mortality rate of 1-3 %. Diagnosing incidental pancreatic lesions, combined with an aging population and increased comorbidities, presents complex therapeutic challenges. This uncertainty raises the question of whether LP presents different morbidity and mortality profiles depending on the neoplasm type, potentially aiding decision-making. Objective: To compare postoperative outcomes by tumor type in a prospective series of LPs in Spain. Methods: The SPANDISPAN Project is a prospective, multicenter, observational study conducted in hepato-pancreato-biliary units from February 2022 to January 2023. A total of 311 patients from 41 Spanish centers participated. Patients were categorized by etiology: Adenocarcinoma (ADC), Intraductal Papillary Mucinous + Mucinous Cystic Neoplasms (IPMN + MCN), Neuroendocrine Tumors (NET), and Others. Pancreatic surgery-specific complications were defined by the International Study Group on Pancreatic Surgery (ISGPS). Results: Postoperative complications were similar overall and for Clavien-Dindo grade > II. No significant differences were observed in POPF, except that grade B/C was more frequent in NET (29.6 %, p < 0.039), mainly due to grade B (53.3 %). No differences were found in PPH or DGE, though the severity of hemorrhage differed significantly (p < 0.035), with grade B more common in Others and grade C in NET (66.7 %). Conclusion: No significant differences in complication rates were found based on etiology. Non-functioning NETs in elderly patients should be carefully assessed due to the increased severity of POPF, PPH, and reoperation rates.