The impact of splenectomy on outcomes after distal and total pancreatectomy (original) (raw)
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Clinical comparison of distal pancreatectomy with or without splenectomy
Journal of Korean medical science, 2008
The spleen may be preserved during distal pancreatectomy (DP) for benign disease. The aim of this study was to compare the perioperative and postoperative courses of patients with conventional DP and spleen-preserving distal pancreatectomy (SPDP) for benign lesions or tumors with low-grade malignant potential occurred at the body or tail of the pancreas. A retrospective analysis was performed for the hospital records of all the patients undergoing DP and SPDP between January 1995 and April 2006. One-hundred forty-three patients underwent DP and 37 patients underwent SPDP. There were no significant differences in age, sex, indications of operation, estimated blood loss, operative time, and postoperative hospital stay between the two groups. Pancreatic fistula occurred in 21 (13.3%) patients following DP and in 3 (8.1%) following SPDP without a significant difference (p=0.081). Portal vein thrombosis occurred in 4 patients after DP. Splenic infarction occurred in one patient after SPD...
Journal of the Pancreas, 2016
Background Recent literature has advocated splenic preservation during distal pancreatectomy. However, no national analysis to date assessed the differences in outcomes between patients who underwent distal pancreatectomy with a concomitant splenectomy and patients who underwent distal pancreatectomy with a splenic preservation. Materials and Methods We performed a retrospective analysis of Nationwide Inpatient Sample database of patients who underwent distal pancreatectomy from 2004 until 2011(8 years). Patients were categorized into two groups: Distal pancreatectomy with splenectomy and distal pancreatectomy with splenic preservation. Results A total of 10,925 patients underwent distal pancreatectomy over the 8-year study period. 76.4% (n = 8,352) of the patients underwent Distal pancreatectomy with splenectomy. On multivariate regression analysis, age (OR [95%CI]: 1.02 [1.1-1.2]), female gender (OR [95%CI]: 1.8 [1.2-2.7]), malignant disease (OR [95%CI]: 1.8[1.0-3.05]), and weeken...
Journal of hepato-biliary-pancreatic sciences, 2018
Minimally invasive distal pancreatectomy (MIDP) has gained in popularity recently. However, the consensus whether to preserve the spleen or not remains inconsistent. In this study, we compared MIDP outcomes between spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS); as well as outcomes between splenic vessel preservation (SVP) and Warshaw's technique (WT). A systematic search of PubMed (MEDLINE) and Cochrane Library was conducted and the reference lists of review articles were hand-searched. Fifteen relevant studies with 769 patients were selected for meta-analyses of DPS and SPDP; while another 15 studies with 841 patients were used for the analysis between SVP and WT. Compared with the DPS group, SPDP patients had significantly lower incidences of infectious complications (P = 0.006) and pancreatic fistula (P = 0.002), shorter operative time (P < 0.001) and less blood loss (P = 0.01). Compared with WT, SVP patients had significan...
HPB, 2011
Objectives: Published data on splenic preservation during distal pancreatectomy have been inconsistent. We hypothesized that patients undergoing spleen-preserving distal pancreatectomy (SPDP) would have fewer infectious and non-infectious complications than those undergoing en bloc distal pancreatectomy with splenectomy (DPS), and that their haematological parameters would be consistent with splenic function. Methods: Of 97 patients who underwent either SPDP using the Warshaw technique or en bloc DPS, 78 met our study inclusion criteria. Records were reviewed for data on age, gender, resection, indications for resection, operative time, blood loss, transfusion requirements, hospital stay, infectious complications, any other complications, postoperative white blood cell (WBC) and platelet counts. Data were analysed using the chi-squared test, the two-sided Mann-Whitney-Wilcoxon text, and simple and multiple logistic regression analyses. A P-value of <0.05 was considered significant. Results: Patients undergoing SPDP had a shorter length of stay and shorter operative time, were more likely to be completed laparoscopically, less likely to require re-operation, and had fewer infectious and non-infectious complications. However, these differences were not statistically significant. In multiple logistic regression analyses, patient age and length of hospital stay were both significant predictors of the occurrence of non-infectious complications (P = 0.04 and P = 0.006, respectively). Blood transfusion was a significant predictor of postoperative morbidity (P = 0.013 for infectious complications; P = 0.018 for non-infectious complications). White blood cell count was a statistically significant predictor of infectious (P = 0.02) and non-infectious (P = 0.04) complications, whereas platelet count was not. Patients who underwent DPS had statistically significantly higher WBC and platelet counts immediately postoperatively and at 6 months compared with SPDP patients. Postoperative mortality in both the SPDP and DPS groups was 0%. None of the 30 SPDP patients had evidence of splenic infarction. Pancreatic leaks occurred in 18% of patients in the SPDP group, compared with 8% in the DPS group (P < 0.05). Conclusions: Spleen-preserving distal pancreatectomy using the Warshaw technique is associated with lower postoperative morbidity than DPS. Lower WBC and platelet counts suggest better splenic function in SPDP patients.
Surgical Endoscopy, 2019
Background The laparoscopic approach in distal pancreatectomy is associated with higher rates of splenic preservation compared to open surgery. Although favorable postoperative short-term outcomes have been reported in open spleen-preserving distal pancreatectomy when compared to distal pancreatectomy with splenectomy, it is unclear whether this observation applies to the laparoscopic approach. The aim of this study is to compare laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with laparoscopic distal pancreatectomy with splenectomy (LDPS). Study design This is a UK wide, propensity score-matched study, including patients who underwent LSPDP or LDPS between 2006 and 2016. Short-term outcomes were compared between LSPDP and LDPS according to intention to treat. Additionally, risk factors for unplanned splenectomy were explored. Results A total of 456 patients were included from eleven centers (229 LSPDP and 227 LDPS). We were able to match 173 LSPDP cases to 173 LDPS cases, according to intention to treat. No differences were seen in postoperative morbidity between the groups. The only identified risk factor for unplanned splenectomy was tumor size ≥ 30 mm. Conclusions Preserving the spleen during laparoscopic distal pancreatectomy is not associated with a lower postoperative morbidity compared to sacrificing the spleen. Tumor size is a risk factor for unplanned splenectomy.
Comparison of Laparoscopic Distal Pancreatectomy with or without Splenic Preservation
Indian Journal of Surgery, 2013
Laparoscopic distal pancreatectomy (LDP) has gained large popularity in recent years, although the choice of whether to preserve the spleen has remained inconsistent. The aim of our study was to report our experiences with LDP and to provide evidence for the safety of the operative technique and an evaluation index of splenic function. We retrospectively evaluated all LDPs performed at our institution between March 2008 and February 2012. Cases were divided into a laparoscopic spleen-preserving distal pancreatectomy (LSPDP) group (n = 14) and an LDP with splenectomy (LDPS) group (n =19). Parametric and nonparametric statistical analyses were used to compare perioperative and oncologic outcomes. Demographic characteristics, operating time, length of stay, estimated blood loss, transfusion requirement, pathologic diagnosis, and complication rate were similar between groups. Patients who underwent LDPS tended to have larger masses and lower pancreatic fistula rates, but these differences were not significant. White blood cell (WBC) counts were significantly higher in the LDPS group than in the LSPDP group on postoperative days 1 and 7. To avoid splenectomy-associated complications, preservation of the spleen and especially the splenic vessels are preferred. This procedure can be performed safely and feasibly. Lower postoperative WBC counts may imply better splenic function.
Journal of Hepato-Biliary-Pancreatic Sciences, 2014
Background The impact of splenectomy on outcomes after distal pancreatectomy was assessed in the present study, with a special emphasis on the postoperative systemic inflammatory response. Methods Thirty-three patients with spleen-preserving distal pancreatectomy-Kimura technique (SPDP group) were compared with a group of distal pancreatectomies with splenectomy (DPS group). The two groups were 1:1 matched for age, gender, co-morbidities and pathology. Results No differences between the groups were observed regarding the overall/severe/infectious morbidity, pancreatic fistulae and postoperative diabetes rates (P-values ≥ 0.475). An increased blood loss (P = 0.031) and need for intraoperative transfusions (P = 0.004) was observed in the DPS group. Postoperative platelet count and platelet-tolymphocyte ratio were significantly higher in the DPS group (P < 0.001). Conclusion Spleen removal during DP is not associated with a higher morbidity but with an increased blood loss and need for intraoperative transfusions. Although the postoperative systemic inflammatory response is higher when the splenectomy is performed, the number of postoperative infectious complications is not influenced. Preservation of the spleen during DP for benign and low-grade malignant tumor of the distal pancreas appears to be worthy and should be the first option whenever is technically feasible and it can be safely achieved.
Clinical Comparison of Distal Pancreatectomy with or without Splenectomy: A Meta-Analysis
Objective: A distal pancreatectomy has routinely been used for removing benign/borderline malignant tumors of the body and tail of the pancreas; however, controversy exists whether or not the spleen should be saved. Therefore, we conducted this meta-analysis for comparing the clinical outcomes of patients who underwent distal pancreatectomy with or without splenectomy. Methods: A literature research from the databases of Medline, Embase, and Cochrane library was performed to evaluate and compare the clinical outcomes between spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS). Pooled odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (95% CI) were calculated using fixed-effects or random-effects models. Results: Eleven non-randomized controlled studies involving 897 patients were selected to satisfy the inclusion criteria; 355 patients underwent SPDP and 542 patients underwent DPS. Compared with DPS, SPDP required a shorter hospital stay (WMD = 1.16, 95% CI = 22.00 to 20.31, P = 0.007), and had a lower incidence of intra-abdominal abscesses (OR = 0.48, 95% CI = 0.27 to 0.83, P = 0.009). In addition, spleen infarctions occurred in SPDP, most of which involved use of the Warshaw method for preserving the spleen. There were no differences between the SPDP and DPS groups with respect to operative time, operative blood loss, requirement for blood transfusion, pancreatic fistulas, thromboses, post-operative bleeding, wound infections and re-operation rates. Conclusion: SPDP should be performed due to the benefits of the immune system and quick post-operative recovery. It is also essential to preserve the splenic artery and vein. Large randomized controlled trials are further needed to verify the results of this meta-analysis.
Journal of Surgical Oncology, 2017
Background: The value of spleen preservation with distal pancreatectomy (DP) for benign and low grade malignant tumors remains unclear. The aim of this study was to evaluate the short-term postoperative clinical outcomes in patients undergoing DP with splenectomy (DPS) or spleen preservation (SPDP). Methods: Online database search was performed (2000 to present); key bibliographies were reviewed. Studies comparing patients undergoing DP with either DPS or SPDP, and assessing postoperative complications were included. Results: Meta-analysis of included data showed SPDP patients had significantly less operative blood loss, shorter duration of hospitalization, lower incidence of fluid collection and abscess, lower incidence of postoperative splenic and portal vein thrombosis, and lower incidence of new onset postoperative diabetes. For the whole group, there was no difference in incidence of postoperative pancreatic fistula (POPF) (RR ¼ 0.95; 95%CI 0.65-1.40, P ¼ 0.80), however, subgroup analysis of studies using ISGPF criteria showed that DPS patients had increased rates of Grade B/C POPF (RR ¼ 1.35; 95%CI 1.08-1.70, P ¼ 0.01). Conclusions: SPDP for benign and low grade malignant tumors is associated with shorter hospital stay and decreased morbidity compared to DPS.