Spleen-preserving distal pancreatectomy in trauma.

BACKGROUND: Traumatic injuries to the distal pancreas are infrequent. Universally accepted recommendations about the need for routine splenectomy with distal pancreatectomy do not exist. The aims of this study were to compare outcomes after distal pancreatectomy and splenectomy versus spleen-preserving distal pancreatectomy, and to define the appropriate patient population for splenic preservation.
METHODS: All patients who underwent distal pancreatectomy (January 1, 2007, to December 31, 2014) were identified from the National Trauma Data Bank. Patients with concomitant splenic injury and those who underwent partial splenectomy were excluded. Demographics, clinical data, procedures, and outcomes were collected. Study groups were defined by surgical procedure: distal pancreatectomy and splenectomy versus spleen-preserving distal pancreatectomy. Baseline characteristics between groups were compared with univariate analysis. Multivariate analysis was performed with logistic and linear regression to examine differences in outcomes.
RESULTS: Over the 8-year study period, 2,223 patients underwent distal pancreatectomy. After excluding 1,381 patients with concomitant splenic injury (62%) and 8 (<1%) who underwent partial splenectomy, 834 (38%) remained for analysis. Median age was 23 years (range, 0-86 years) and 634 (77%) were male. Mechanism of injury was penetrating in 413 (50%) patients. Of the 834 patients, 469 (56%) underwent splenectomy and 365 (44%) patients did not. Compared with patients who underwent distal pancreatectomy and splenectomy, those who underwent spleen-preserving distal pancreatectomy were younger (p < 0.001), more likely to have sustained blunt trauma (p < 0.001), and had a lower Injury Severity Score (p < 0.001). On multivariate analysis, only hospital length of stay (LOS) was significantly shorter among patients undergoing spleen-preserving distal pancreatectomy (p = 0.017). Complications, mortality, and intensive care unit LOS were not significantly different.
CONCLUSION: In young patients after blunt trauma who are not severely injured, a spleen-preserving distal pancreatectomy should be considered to allow for conservation of splenic function and a shorter hospital LOS. In all other patients, the surgeon should not hesitate to remove the spleen with the distal pancreas. LEVEL OF EVIDENCE: Therapy, level IV.