Maarten Korrel1, Sanne Lof, Bilal Al Sarireh, Bergthor Björnsson, Ugo Boggi, Giovanni Butturini, Riccardo Casadei, Matteo De Pastena, Alessandro Esposito, Jean Michel Fabre, Giovanni Ferrari, Fadhel Samir Fteriche, Giuseppe Fusai, Bas Groot Koerkamp, Thilo Hackert, Mathieu D'Hondt, Asif Jah, Tobias Keck, Marco V Marino, I Quintus Molenaar, Patrick Pessaux, Andrea Pietrabissa, Edoardo Rosso, Mushegh Sahakyan, Zahir Soonawalla, Francois Regis Souche, Steve White, Alessandro Zerbi, Safi Dokmak, Bjorn Edwin, Mohammad Abu Hilal, Marc Besselink. 1. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy Department of Surgery, Morriston Hospital, Swansea, United Kingdom Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Sweden Division of General and Transplant Surgery, University of Pisa, Pisa, Italy Department of Surgery, Pederzoli Hospital, Peschiera, Italy Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy Department of Surgery, Hopital Saint Eloi, Montpellier, France Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy Department of Surgery, Hospital of Beaujon, Clichy, France Department of Surgery, Royal Free Hospital NHS Foundation Trust, London, United Kingdom Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium Department of Hepatobiliary and Pancreatic Surgery, Addenbrooke's Hospital, Cambridge, UK Department of Surgery, University Hospital Schleswig Holstein, Campus Lübeck, Lübeck, Germany Emergency and General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy and General Surgery Department, Policlinico Abano Terme, Italy Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein, Utrecht University, Utrecht, the Netherlands Department of Visceral and Digestive Surgery, Nouvel Hôpital Civil, University hospital of Strasbourg Department of Surgery, University hospital Pavia, Pavia, Italy The Intervention Center, Department of HPB Surgery, Department of Research & Development, Division of Emergencies and Critical Care Oslo University Hospital and Institute for Clinical Medicine, University of Oslo, Norway Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom Department of Surgery, the Freeman Hospital Newcastle Upon Tyne, Newcastle, United Kingdom Pancreatic Surgery, Humanitas IRCCS, Rozzano and Humanitas University, Department of Biomedical Sciences, Milan, Italy Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom.
Abstract
OBJECTIVE: To compare short-term clinical outcomes after Kimura and Warshaw minimally invasive distal pancreatectomy (MIDP). BACKGROUND: Spleen preservation during distal pancreatectomy can be achieved by either preservation (Kimura) or resection (Warshaw) of the splenic vessels. Multicenter studies reporting outcomes of Kimura and Warshaw spleen-preserving MIDP are scarce. METHODS: Multicenter retrospective study including consecutive MIDP procedures intended to be spleen-preserving from 29 high-volume centers (≥15 distal pancreatectomies annually) in eight European countries. Primary outcomes were secondary splenectomy for ischemia and major (Clavien-Dindo grade ≥III) complications. Sensitivity analysis assessed the impact of excluding ('rescue') Warshaw procedures which were performed in centers that typically (>75%) performed Kimura MIDP. RESULTS: Overall, 1095 patients after MIDP were included with successful splenic preservation in 878 patients (80%), including 634 Kimura and 244 Warshaw procedures. Rates of clinically relevant splenic ischemia (0.6% vs. 1.6%, p = 0.127) and major complications (11.5% vs 14.4%, p = 0.308) did not differ significantly between Kimura and Warshaw MIDP, respectively. Mortality rates were higher after Warshaw MIDP (0.0% vs. 1.2%, p = 0.023), and decreased in the sensitivity analysis (0.0% vs 0.6%, p = 0.052). Kimura MIDP was associated with longer operative time (202 vs 184 min, p = 0.033) and less blood loss (100 vs 150 ml, p < 0.001) as compared to Warshaw MIDP. Unplanned splenectomy was associated with a higher conversion rate (20.7% vs 5.0%, p < 0.001). CONCLUSION: Kimura and Warshaw spleen-preserving MIDP provide equivalent short-term outcomes with low rates of secondary splenectomy and postoperative morbidity. Further analyses of long-term outcomes are needed.
OBJECTIVE: To compare short-term clinical outcomes after Kimura and Warshaw minimally invasive distal pancreatectomy (MIDP). BACKGROUND: Spleen preservation during distal pancreatectomy can be achieved by either preservation (Kimura) or resection (Warshaw) of the splenic vessels. Multicenter studies reporting outcomes of Kimura and Warshaw spleen-preserving MIDP are scarce. METHODS: Multicenter retrospective study including consecutive MIDP procedures intended to be spleen-preserving from 29 high-volume centers (≥15 distal pancreatectomies annually) in eight European countries. Primary outcomes were secondary splenectomy for ischemia and major (Clavien-Dindo grade ≥III) complications. Sensitivity analysis assessed the impact of excluding ('rescue') Warshaw procedures which were performed in centers that typically (>75%) performed Kimura MIDP. RESULTS: Overall, 1095 patients after MIDP were included with successful splenic preservation in 878 patients (80%), including 634 Kimura and 244 Warshaw procedures. Rates of clinically relevant splenic ischemia (0.6% vs. 1.6%, p = 0.127) and major complications (11.5% vs 14.4%, p = 0.308) did not differ significantly between Kimura and Warshaw MIDP, respectively. Mortality rates were higher after Warshaw MIDP (0.0% vs. 1.2%, p = 0.023), and decreased in the sensitivity analysis (0.0% vs 0.6%, p = 0.052). Kimura MIDP was associated with longer operative time (202 vs 184 min, p = 0.033) and less blood loss (100 vs 150 ml, p < 0.001) as compared to Warshaw MIDP. Unplanned splenectomy was associated with a higher conversion rate (20.7% vs 5.0%, p < 0.001). CONCLUSION: Kimura and Warshaw spleen-preserving MIDP provide equivalent short-term outcomes with low rates of secondary splenectomy and postoperative morbidity. Further analyses of long-term outcomes are needed.