Kohei Nakata1, Satoru Shikata2, Takao Ohtsuka1, Tomohiko Ukai3, Yoshihiro Miyasaka1, Yasuhisa Mori1, Vittoria Vanessa D M Velasquez1, Yoshitaka Gotoh1, Daisuke Ban4, Yoshiharu Nakamura5, Yuichi Nagakawa6, Minoru Tanabe4, Yatsuka Sahara6, Kyoichi Takaori7, Goro Honda8, Takeyuki Misawa9, Manabu Kawai10, Hiroki Yamaue10, Takanori Morikawa11, Tamotsu Kuroki12, Yiping Mou13, Woo-Jung Lee14, Shailesh V Shrikhande15, Chung Ngai Tang16, Claudius Conrad17, Ho-Seong Han18, Palanivelu Chinnusamy19, Horacio J Asbun20, David A Kooby21, Go Wakabayashi22, Tadahiro Takada23, Masakazu Yamamoto24, Masafumi Nakamura1. 1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 2. Mie Prefectural Ichishi Hospital, Tsu-Shi, Mie, Japan. 3. Department of Community Medicine, Mie University School of Medicine, Tsu, Mie, Japan. 4. Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 5. Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan. 6. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan. 7. Division of Hepatobiliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan. 8. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. 9. Department of Surgery, Tokyo Jikei University School of Medicine, Tokyo, Japan. 10. Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan. 11. Department of Surgery, Tohoku University, Sendai, Japan. 12. Department of Surgery, National Hospital Nagasaki Medical Center, Nagasaki, Japan. 13. Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China. 14. Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea. 15. Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India. 16. Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China. 17. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 18. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea. 19. Division of Gastrointestinal Surgery and Minimal Access Surgery, GEM Hospital and Research Centre, Coimbatore, India. 20. Department of Surgery, Mayo Clinic, Jacksonville, FL, USA. 21. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. 22. Department of Surgery, Ageo Central General Hospital, Ageo, Japan. 23. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. 24. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
BACKGROUND: Minimally invasive distal pancreatectomy (MIDP) has gained in popularity recently. However, there is no consensus on whether to preserve the spleen or not. 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). METHODS: A systematic search of PubMed (MEDLINE) and Cochrane Library was conducted and the reference lists of review articles were hand-searched. RESULTS: 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 significantly lower incidences of splenic infarction (P < 0.001) and secondary splenectomy (P = 0.003). Subanalysis for laparoscopic surgery alone had similar results. CONCLUSIONS: Based on this study, SPDP has significantly superior outcomes compared to DPS. When a spleen is preserved, SVP has better outcomes over WT for reducing splenic complications.
BACKGROUND: Minimally invasive distal pancreatectomy (MIDP) has gained in popularity recently. However, there is no consensus on whether to preserve the spleen or not. 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). METHODS: A systematic search of PubMed (MEDLINE) and Cochrane Library was conducted and the reference lists of review articles were hand-searched. RESULTS: 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 significantly lower incidences of splenic infarction (P < 0.001) and secondary splenectomy (P = 0.003). Subanalysis for laparoscopic surgery alone had similar results. CONCLUSIONS: Based on this study, SPDP has significantly superior outcomes compared to DPS. When a spleen is preserved, SVP has better outcomes over WT for reducing splenic complications.
Authors: James R Howe; Nipun B Merchant; Claudius Conrad; Xavier M Keutgen; Julie Hallet; Jeffrey A Drebin; Rebecca M Minter; Terry C Lairmore; Jennifer F Tseng; Herbert J Zeh; Steven K Libutti; Gagandeep Singh; Jeffrey E Lee; Thomas A Hope; Michelle K Kim; Yusuf Menda; Thorvardur R Halfdanarson; Jennifer A Chan; Rodney F Pommier Journal: Pancreas Date: 2020-01 Impact factor: 3.327
Authors: Madeline Chee; Chuan-Yaw Lee; Ser-Yee Lee; London L P J Ooi; Alexander Y F Chung; Chung-Yip Chan; Brian K P Goh Journal: J Minim Access Surg Date: 2022 Jan-Mar Impact factor: 1.407