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Lee O, Yoon SK, Yoon SJ, Kim H, Han IW, Heo JS, Shin SH. Fate of small remnant pancreatic tail in splenic hilum after laparoscopic spleen preserving distal pancreatectomy: a retrospective study. Ann Surg Treat Res 2024; 106:211-217. [PMID: 38586554 PMCID: PMC10995840 DOI: 10.4174/astr.2024.106.4.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose When performing laparoscopic spleen-preserving distal pancreatectomy (LSPDP), sometimes, anatomically challenging patients are encountered, where the pancreatic tail is deep in the splenic hilum. The purpose of this study was to discuss the experience with the surgical technique of leaving the deep pancreatic tail of the splenic hilum in these patients. Methods Eleven patients who underwent LSPDP with remnant pancreatic tails between November 2019 and August 2021 at Samsung Medical Center in Seoul, Korea were included in the study. Their short-term postoperative outcomes were analyzed retrospectively. Results The mean operative time was 168.6 ± 26.0 minutes, the estimated blood loss was 172.7 ± 95.8 mL, and the postoperative length of stay was 6.1 ± 1.0 days. All 11 lesions were in the body or tail of the pancreas and included 2 intraductal papillary mucinous neoplasms, 6 neuroendocrine tumors, 2 cystic neoplasms, and 1 patient with chronic pancreatitis. In 10 of the 11 patients, only the pancreatic tail was left inside the distal portion of the splenic hilum of the branching splenic vessel, and there was a collection of intraabdominal fluid, which was naturally resolved. One patient with a remnant pancreatic tail above the hilar vessels was readmitted due to a postoperative pancreatic fistula with fever and underwent internal drainage. Conclusion In spleen preservation, leaving a small pancreatic tail inside the splenic hilum is feasible and more beneficial to the patient than performing splenectomy in anatomically challenging patients.
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Affiliation(s)
- Okjoo Lee
- Division of Hepatobiliary-pancreatic Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - So Kyung Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - So Jeong Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hongbeom Kim
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hajibandeh S, Ghassemi N, Hajibandeh S, Romman S, Ghassemi A, Laing RW, Bhatt A, Athwal TS, Durkin D. Meta-analysis of laparoscopic spleen-preserving distal pancreatectomy versus laparoscopic distal pancreatectomy with splenectomy: An insight into confounding by indication. Surgeon 2024; 22:e13-e25. [PMID: 37673704 DOI: 10.1016/j.surge.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
AIMS To evaluate comparative outcomes of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and laparoscopic distal pancreatectomy with splenectomy (LDPS). METHODS A systematic search of multiple electronic data sources and bibliographic reference lists were conducted. Comparative studies reporting outcomes of LSPDP and LDPS were considered followed by evaluation of the associated risk of bias according to ROBINS-I tool. Perioperative complications, clinically important postoperative pancreatic fistula (POPF), infectious complications, blood loss, conversion to open, operative time and duration of hospital stay were the investigated outcome parameters. RESULTS Nineteen studies were identified enrolling 3739 patients of whom 1860 patients underwent LSPDP and the remaining 1879 patients had LDPS. The patients in the LSPDP and LDPS groups were of comparable age (p = 0.73), gender (p = 0.59), and BMI (p = 0.07). However, the patient in the LDPS group had larger tumour size (p = 0.0004) and more malignant lesions (p = 0.02). LSPDP was associated with significantly lower POPF (OR:0.65, p = 0.02), blood loss (MD:-28.30, p = 0.001), and conversion to open (OR:0.48, p < 0.0001) compared to LDPS. Moreover, it was associated with significantly shorter procedure time (MD: -22.06, p = 0.0009) and length of hospital stay (MD: -0.75, p = 0.005). However, no significant differences were identified in overall perioperative (OR:0.89, p = 0.25) or infectious (OR:0.67, p = 0.05) complications between two groups. CONCLUSIONS LSPDP seems to be associated with lower POPF, bleeding and conversion to open compared to LDPS in patients with small-sized benign tumours. Moreover, it may be quicker and reduce hospital stay. Nevertheless, such advantages are of doubtful merit about large-sized or malignant tumours. The available evidence is subject to confounding by indication.
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Affiliation(s)
- Shahin Hajibandeh
- Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
| | - Nader Ghassemi
- Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Shahab Hajibandeh
- Department of Hepatobiliary and Pancreatic Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Saleh Romman
- Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Ali Ghassemi
- Gemelli University Hospital, School of Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Richard W Laing
- Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Anand Bhatt
- Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Tejinderjit S Athwal
- Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Damien Durkin
- Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
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Timmerhuis HC, Ngongoni RF, Jensen CW, Baiocchi M, DeLong JC, Dua MM, Norton JA, Poultsides GA, Worth PJ, Visser BC. Comparison of Spleen-Preservation Versus Splenectomy in Minimally Invasive Distal Pancreatectomy. J Gastrointest Surg 2023; 27:2166-2176. [PMID: 37653153 DOI: 10.1007/s11605-023-05809-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/29/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Spleen-preservation during minimally invasive distal pancreatectomy (MIDP) can be technically challenging and remains controversial. Our primary aim was to compare MIDP and splenectomy with spleen-preserving MIDP. Secondarily, we compared two spleen-preserving techniques. METHODS Adults undergoing MIDP (2007-2021) were retrospectively included in this single-center study. Intraoperative and postoperative outcomes between spleen-preservation and splenectomy and between the two spleen-preserving techniques were compared using the Mann-Whitney U test for continuous data, and Fisher's exact test for categorical data. RESULTS Of the 293 patients who underwent MIDP, preservation of the spleen was intended in 208 (71%) patients. Spleen-preservation was achieved in 174 patients (84%) via the Warshaw technique (130; 75%) or vessel-preservation (44; 25%). The spleen-preserving group had shorter length of stay (3 vs 4 days, p < 0.01), fewer conversions to open (1 vs 12, p < 0.01) and less blood loss (p < 0.01) compared to the splenectomy group. Operative (OR) times were comparable (229 vs 214 min, p = 0.67). Except for the operative time, which was longer for the Warshaw technique (245 vs 183 min, p = 0.01), no other differences between the two spleen-preserving techniques were found. At a median follow-up of 43 (IQR 18-79) months after spleen-preservation, only 2 (1.1%) patients had required splenectomy (1 partial splenectomy for infarct/abscess after Warshaw, 1 for variceal bleeding after vessel-preserving). CONCLUSIONS Spleen-preservation is not associated with increased risk of blood loss, longer hospital stay, conversion, nor lengthy OR times. Late splenectomy is very rarely required. Given the immune consequences of splenectomy, spleen-preservation should be strongly considered in MIDP.
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Affiliation(s)
- Hester C Timmerhuis
- Department of Surgery, Section of Hepatobiliary Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Rejoice F Ngongoni
- Department of Surgery, Section of Hepatobiliary Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | | | - Michael Baiocchi
- Stanford Prevention Research Center and Departments of Statistics and Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Jonathan C DeLong
- Department of Surgery, Section of Hepatobiliary Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Monica M Dua
- Department of Surgery, Section of Hepatobiliary Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Jeffrey A Norton
- Department of Surgery, Section of Hepatobiliary Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - George A Poultsides
- Department of Surgery, Section of Hepatobiliary Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Patrick J Worth
- Department of Surgery, Section of Hepatobiliary Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Brendan C Visser
- Department of Surgery, Section of Hepatobiliary Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
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Korrel M, Lof S, Al Sarireh B, Björnsson B, Boggi U, Butturini G, Casadei R, De Pastena M, Esposito A, Fabre JM, Ferrari G, Fteriche FS, Fusai G, Koerkamp BG, Hackert T, D'Hondt M, Jah A, Keck T, Marino MV, Molenaar IQ, Pessaux P, Pietrabissa A, Rosso E, Sahakyan M, Soonawalla Z, Souche FR, White S, Zerbi A, Dokmak S, Edwin B, Hilal MA, Besselink M; European consortium on Minimally Invasive Pancreatic Surgery (E-MIPS). Short-term Outcomes After Spleen-preserving Minimally Invasive Distal Pancreatectomy With or Without Preservation of Splenic Vessels: A Pan-European Retrospective Study in High-volume Centers. Ann Surg 2023; 277:e119-25. [PMID: 34091515 DOI: 10.1097/SLA.0000000000004963] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare short-term clinical outcomes after Kimura and Warshaw 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 8 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 minutes, 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). CONCLUSIONS 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.
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Zhu A, Greene B, Tsang M, Jayaraman S. Comparing the Warshaw technique with vessel-preservation in laparoscopic spleen preserving distal pancreatectomy: is there a better approach? HPB (Oxford) 2023; 25:109-115. [PMID: 36257873 DOI: 10.1016/j.hpb.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) can be accomplished with either resection of the splenic vessels via the Warshaw Technique (WT) or via preservation of the splenic vessels (SVP). Our study aims to compare outcomes for the two methods of LSPDP. METHODS We performed a retrospective chart review with intent-to-treat analysis of adults undergoing LSPDP at a single institution from 2009 to 2021. We compared demographic characteristics, operative parameters, oncologic pathology review, and postoperative outcomes. RESULTS There were 102 consecutive cases of LSPDP (59 WT, 43 SVP) over 12 years. The rate of successful spleen preservation was not significantly different between the two groups (76.3%WT, 65.1%VSP,p = 0.27). Rates of conversion to laparotomy, postoperative complications including pancreatic fistulas and splenic infarcts and amount of intraoperative blood loss were similar between the groups. Median operative time was significantly shorter with the WT (141 vs. 177 min, p < 0.05). The median length of stay in hospital was not significantly different among the groups. CONCLUSION Both techniques are safe and effective in preserving the spleen in laparoscopic distal pancreatectomy. Our experience suggests that the Warshaw Technique may be more efficient with respect to the use of limited operative resources.
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Affiliation(s)
- Alice Zhu
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Brittany Greene
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of General Surgery, University of Toronto, Toronto, ON, Canada; HPB Service, St. Joseph's Health Centre, Unity Health Toronto, Toronto, ON, Canada
| | - Melanie Tsang
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of General Surgery, University of Toronto, Toronto, ON, Canada; HPB Service, St. Joseph's Health Centre, Unity Health Toronto, Toronto, ON, Canada
| | - Shiva Jayaraman
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of General Surgery, University of Toronto, Toronto, ON, Canada; HPB Service, St. Joseph's Health Centre, Unity Health Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
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6
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Zhang RC, Ma J, Mou YP, Yan JF, Zhou YC. Comparison of clinical outcomes and quality of life between laparoscopic distal pancreatectomy with or without spleen preservation. Surg Endosc 2020; 35:3412-3420. [PMID: 32632480 DOI: 10.1007/s00464-020-07783-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The studies comparing laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and laparoscopic distal pancreatosplenectomy (LDPS) are limited. This study aimed to compare clinical outcomes and quality of life of patients undergoing LSPDP and LDPS. METHODS Between March 2004 and December 2014, patients who underwent laparoscopic distal pancreatectomy were reviewed. Patients were divided into 2 groups as LSPDP and LDPS. Data considered for comparison analysis were patient demographics, intraoperative variables, morbidity, postoperative hospital stay, mortality, pathologic findings, and quality of life (SF-36 questionnaire). RESULTS A total of 110 patients (50 LSPDP and 60 LDPS) were included in the final analysis. Baseline characteristics were similar in the 2 groups. The LSPDP group had a significantly shorter operative time(153.3 ± 46.2 vs. 179.9 ± 54.1 min, p = 0.015) than the LDPS group. Also in analysis of propensity-matched population(LSPDP:LDPS = 35:35, 1:1 matching), LSPDP group still had a significantly shorter operative time (159.3 ± 36.2 vs. 172.9 ± 44.1 min, p = 0.045) than the LDPS group.There were no significant differences with respect to estimated blood loss, first flatus time, diet start time, and postoperative hospital stay. Postoperative outcomes, including morbidity, pancreatic fistula rates, and mortality, were similar in the LSPDP and LDPS group. On the follow-up survey, the total quality of life score (635.8 ± 50.7 vs. 596.1 ± 92.1)was higher in the LSPDP group compared with the LDPS group. However, the differences were not statistically significant(p > 0.05). The score in vitality (82.5 ± 14.4 vs. 68.9 ± 11.4, p = 0.046) was significantly higher in LSPDP group and not statistically significant in other areas (p > 0.05).Similar results of quality of life assessment were found in analysis of propensity-matched population. CONCLUSIONS Compared to LDPS, LSPDP had shorter operating time and better quality of life with similar morbidity and recovery period.
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Affiliation(s)
- Ren-Chao Zhang
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
| | - Jun Ma
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
| | - Yi-Ping Mou
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China.
| | - Jia-Fei Yan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang Province, China
| | - Yu-Cheng Zhou
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
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Moekotte AL, Lof S, White SA, Marudanayagam R, Al-Sarireh B, Rahman S, Soonawalla Z, Deakin M, Aroori S, Ammori B, Gomez D, Marangoni G, Abu Hilal M. Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study. Surg Endosc 2019; 34:1301-1309. [PMID: 31236723 PMCID: PMC7012970 DOI: 10.1007/s00464-019-06901-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/06/2019] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Alma L Moekotte
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 2YD, UK.
| | - Sanne Lof
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 2YD, UK
| | - Steve A White
- Department of Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Ravi Marudanayagam
- Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Sakhanat Rahman
- Department of Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Zahir Soonawalla
- Department of Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark Deakin
- Department of Surgery, Royal Stoke University Hospital, Stoke, UK
| | - Somaiah Aroori
- Department of Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Basil Ammori
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Dhanny Gomez
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gabriele Marangoni
- Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mohammed Abu Hilal
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 2YD, UK
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8
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Milito P, Aiolfi A, Asti E, Rausa E, Bonitta G, Bonavina L. Impact of Spleen Preserving Laparoscopic Distal Pancreatectomy on Postoperative Infectious Complications: Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 29:167-177. [PMID: 30592691 DOI: 10.1089/lap.2018.0738] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Laparoscopic distal pancreatectomy with splenectomy is the standard procedure for body and tail pancreatic tumors. Technical difficulties arising from the strict anatomical relationship between pancreas and splenic vessels generally impose a concomitant splenectomy. Previous retrospective studies have shown a reduced risk of postoperative complications and infections in spleen preserved patients, but this is still a debated issue. Aim of this systematic review and meta-analysis was to provide a more robust evidence on the effect of spleen preserving laparoscopic distal pancreatectomy. METHODS PubMed, MEDLINE, Embase, and Cochrane databases were consulted. Pooled effect measures were calculated using an inverse-variance weighted or Mantel-Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I2-index and Cochran Q-test. RESULTS Ten observational studies were eligible, and 632 patients were included in the quantitative analysis. Overall, 296 (46.8%) patients underwent laparoscopic distal pancreatectomy with splenectomy (Group S), and 336 (53.2%) patients underwent spleen-preserving laparoscopic distal pancreatectomy (Group SP). In-hospital mortality was 0%. In the group S, the estimated pooled odds ratio of postoperative surgical site infection (SSI) and overall complications was 1.51 (95% confidence interval [CI]: 1.01-2.28; P = .048) and 2.30 (95% CI: 1.11-4.76; P = .024). The estimated pooled odds ratio of pancreatic fistula, postoperative bleeding, and reoperation was 1.64 (P = .094), 1.01 (P = .987), and 1.24 (P = .776), respectively. CONCLUSIONS Spleen-preserving laparoscopic distal pancreatectomy may reduce postoperative SSI and overall complications. These results should be interpreted with caution but seem meaningful to establish a better evidence-based treatment for distal pancreatic tumors. Further studies are warranted to analyze the role of spleen preserving laparoscopic distal pancreatectomy on long-term outcomes.
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Affiliation(s)
- Pamela Milito
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Alberto Aiolfi
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Emanuele Asti
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Emanuele Rausa
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Gianluca Bonitta
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
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9
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Nakata K, Shikata S, Ohtsuka T, Ukai T, Miyasaka Y, Mori Y, Velasquez VVDM, Gotoh Y, Ban D, Nakamura Y, Nagakawa Y, Tanabe M, Sahara Y, Takaori K, Honda G, Misawa T, Kawai M, Yamaue H, Morikawa T, Kuroki T, Mou Y, Lee WJ, Shrikhande SV, Tang CN, Conrad C, Han HS, Chinnusamy P, Asbun HJ, Kooby DA, Wakabayashi G, Takada T, Yamamoto M, Nakamura M. Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis. J Hepatobiliary Pancreat Sci 2018; 25:476-488. [DOI: 10.1002/jhbp.569] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kohei Nakata
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | | | - Takao Ohtsuka
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Tomohiko Ukai
- Department of Community Medicine; Mie University School of Medicine; Tsu Mie Japan
| | - Yoshihiro Miyasaka
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | | | - Yoshitaka Gotoh
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery; Graduate School of Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery; Nippon Medical School; Tokyo Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery; Tokyo Medical University; Tokyo Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery; Graduate School of Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Yatsuka Sahara
- Department of Gastrointestinal and Pediatric Surgery; Tokyo Medical University; Tokyo Japan
| | - Kyoichi Takaori
- Division of Hepatobiliary-Pancreatic Surgery and Transplantation; Department of Surgery; Kyoto University; Kyoto Japan
| | - Goro Honda
- Department of Surgery; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; Tokyo Japan
| | - Takeyuki Misawa
- Department of Surgery; Tokyo Jikei University School of Medicine; Tokyo Japan
| | - Manabu Kawai
- Second Department of Surgery; School of Medicine; Wakayama Medical University; Wakayama Japan
| | - Hiroki Yamaue
- Second Department of Surgery; School of Medicine; Wakayama Medical University; Wakayama Japan
| | | | - Tamotsu Kuroki
- Department of Surgery; National Hospital Nagasaki Medical Center; Nagasaki Japan
| | - Yiping Mou
- Department of Gastrointestinal and Pancreatic Surgery; Zhejiang Provincial People's Hospital; People's Hospital of Hangzhou Medical College; Zhejiang China
| | - Woo-Jung Lee
- Department of Hepatobiliary and Pancreatic Surgery; Yonsei University College of Medicine; Seoul Korea
| | - Shailesh V. Shrikhande
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology; Tata Memorial Hospital; Mumbai India
| | - Chung Ngai Tang
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - Claudius Conrad
- Department of Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Ho-Seong Han
- Department of Surgery; Seoul National University College of Medicine; Seoul National University Bundang Hospital; Seoul Korea
| | - Palanivelu Chinnusamy
- Division of Gastrointestinal Surgery and Minimal Access Surgery; GEM Hospital and Research Centre; Coimbatore India
| | | | - David A. Kooby
- Department of Surgery; Emory University School of Medicine; Atlanta GA USA
| | - Go Wakabayashi
- Department of Surgery; Ageo Central General Hospital; Ageo Japan
| | - Tadahiro Takada
- Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
| | - Masakazu Yamamoto
- Department of Surgery; Institute of Gastroenterology; Tokyo Women's Medical University; Tokyo Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
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10
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Pendola F, Gadde R, Ripat C, Sharma R, Picado O, Lobo L, Sleeman D, Livingstone AS, Merchant N, Yakoub D. Distal pancreatectomy for benign and low grade malignant tumors: Short-term postoperative outcomes of spleen preservation-A systematic review and update meta-analysis. J Surg Oncol 2017; 115:137-143. [PMID: 28133818 DOI: 10.1002/jso.24507] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 10/21/2016] [Indexed: 12/15/2022]
Abstract
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 = 0.95; 95%CI 0.65-1.40, P = 0.80), however, subgroup analysis of studies using ISGPF criteria showed that DPS patients had increased rates of Grade B/C POPF (RR = 1.35; 95%CI 1.08-1.70, P = 0.01). CONCLUSIONS SPDP for benign and low grade malignant tumors is associated with shorter hospital stay and decreased morbidity compared to DPS. J. Surg. Oncol. 2017;115:137-143. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Fiorella Pendola
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, Florida
| | - Rahul Gadde
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Caroline Ripat
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Rishika Sharma
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Omar Picado
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Laila Lobo
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Danny Sleeman
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Alan S Livingstone
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, Florida
| | - Nipun Merchant
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, Florida
| | - Danny Yakoub
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, Florida
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11
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Edwin B, Sahakyan MA, Abu Hilal M, Besselink MG, Braga M, Fabre JM, Fernández-Cruz L, Gayet B, Kim SC, Khatkov IE; EAES Consensus Conference Study Group. Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference. Surg Endosc 2017; 31:2023-41. [PMID: 28205034 DOI: 10.1007/s00464-017-5414-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/07/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Introduced more than 20 years ago, laparoscopic pancreatic surgery (LAPS) has not reached a uniform acceptance among HPB surgeons. As a result, there is no consensus regarding its use in patients with pancreatic neoplasms. This study, organized by the European Association for Endoscopic Surgery (EAES), aimed to develop consensus statements and clinical recommendations on the application of LAPS in these patients. METHODS An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreatic surgery. Each panelist performed a critical appraisal of the literature and prepared evidence-based statements assessed by other panelists during Delphi process. The statements were further discussed during a one-day face-to-face meeting followed by the second round of Delphi. Modified statements were presented at the plenary session of the 24th International Congress of the EAES in Amsterdam and in a web-based survey. RESULTS LAPS included laparoscopic distal pancreatectomy (LDP), pancreatoduodenectomy (LPD), enucleation, central pancreatectomy, and ultrasound. In general, LAPS was found to be safe, especially in experienced hands, and also advantageous over an open approach in terms of intraoperative blood loss, postoperative recovery, and quality of life. Eighty-five percent or higher proportion of responders agreed with the majority (69.5%) of statements. However, the evidence is predominantly based on retrospective case-control studies and systematic reviews of these studies, clearly affected by selection bias. Furthermore, no randomized controlled trials (RCTs) have been published to date, although four RCTs are currently underway in Europe. CONCLUSIONS LAPS is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. LDP is feasible and safe, performed in many centers, while LPD is limited to few centers. RCTs and registry studies are essential to proceed with the assessment of LAPS.
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12
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Kwon W, Jang JY, Kim JH, Chang YR, Jung W, Kang MJ, Kim SW. An Analysis of Complications, Quality of Life, and Nutritional Index After Laparoscopic Distal Pancreatectomy with Regard to Spleen Preservation. J Laparoendosc Adv Surg Tech A 2016; 26:335-42. [DOI: 10.1089/lap.2015.0171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ye Rim Chang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Woohyun Jung
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Mee Joo Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Whe Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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13
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Chen JH, Huang KF, Li CH. Preservation of splenic vessels during laparoscopic spleen-preserving distal pancreatectomy via lateral approach. Wideochir Inne Tech Maloinwazyjne 2015; 10:382-8. [PMID: 26649084 DOI: 10.5114/wiitm.2015.54188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/08/2015] [Accepted: 07/17/2015] [Indexed: 01/19/2023] Open
Abstract
Introduction Preserving splenic vessels during laparoscopic distal pancreatectomy (SPDP-LA) is feasible and avoids unnecessary splenectomy. Aim To present our outcomes for this unique technique. Material and methods Between January 1998 and January 2012, 6 patients who underwent SPDP-LA for benign or low malignancy tumors in the pancreatic tail were included. Clinical characteristics as well as perioperative data were retrospectively recorded. Results All procedures were successful, with an average operative time of 184 min (range: 88–277 min) and average blood loss of 401.7 ml (range: 10–900 ml). The mean hospital stay was 7 days. Pancreatic fistula occurred in 2 patients but was then cured by external drainage. There was no mortality. Follow-ups were available for all patients. Conclusions Our experience was characterized by a lack of conversions and by acceptable rates of postoperative fistula and morbidity. The lateral approach showed beneficial results in patients without complications and short post-operative hospital stays.
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14
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Mohkam K, Farges O, Pruvot FR, Muscari F, Régimbeau JM, Regenet N, Sa Cunha A, Dokmak S, Mabrut JY. Toward a standard technique for laparoscopic distal pancreatectomy? Synthesis of the 2013 ACHBT Spring workshop. J Visc Surg 2015; 152:167-78. [DOI: 10.1016/j.jviscsurg.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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15
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Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G, Kössler-Ebs J, Müller-Stich BP, Büchler MW, Hackert T, Diener MK. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it's time to randomize. Surgery 2015; 157:45-55. [PMID: 25482464 DOI: 10.1016/j.surg.2014.06.081] [Citation(s) in RCA: 210] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/30/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic distal pancreatectomy is regarded as a feasible and safe surgical alternative to open distal pancreatectomy for lesions of the pancreatic tail and body. The aim of the present systematic review was to provide recommendations for clinical practice and research on the basis of surgical morbidity, such as pancreas fistula, delayed gastric empting, safety, and clinical significance of laparoscopic versus open distal pancreatectomy for malignant and nonmalignant diseases of the pancreas. METHODS A systematic literature search (MEDLINE) was performed to identify all types of studies comparing laparoscopic distal pancreatectomy and open distal pancreatectomy. Random effects meta-analyses were calculated after critical appraisal of the included studies and presented as odds ratios or mean differences each with corresponding 95% confidence intervals. RESULTS A total of 4,148 citations were retrieved initially; available data of 29 observational studies (3,701 patients overall) were included in the meta-analyses. Five systematic reviews on the same topic were found and critically appraised. Meta-analyses showed superiority of laparoscopic distal pancreatectomy in terms of blood loss, time to first oral intake, and hospital stay. All other parameters of operative morbidity and safety showed no difference. Data on oncologic radicality and effectiveness are limited. CONCLUSION Laparoscopic distal pancreatectomy seems to be a safe and effective alternative to open distal pancreatectomy. No more nonrandomized trials are needed within this context. A large, randomized trial is warranted and should focus on oncologic effectiveness, defined end points, and cost-effectiveness.
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Affiliation(s)
- Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
| | - Mohammadreza Hafezi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jalal Arvin
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Majid Esmaeilzadeh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Camelia Garoussi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Golnaz Emami
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Julia Kössler-Ebs
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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16
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He Z, Qian D, Hua J, Gong J, Lin S, Song Z. Clinical comparison of distal pancreatectomy with or without splenectomy: a meta-analysis. PLoS One. 2014;9:e91593. [PMID: 24682038 PMCID: PMC3969315 DOI: 10.1371/journal.pone.0091593] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 02/12/2014] [Indexed: 12/14/2022] Open
Abstract
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 = −2.00 to −0.31, 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.
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17
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Zhu YP, Ni JJ, Chen RB, Matro E, Xu XW, Li B, Hu HJ, Mou YP. Successful interventional radiological management of postoperative complications of laparoscopic distal pancreatectomy. World J Gastroenterol 2013; 19:8453-8458. [PMID: 24363541 PMCID: PMC3857473 DOI: 10.3748/wjg.v19.i45.8453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 10/10/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
During the past decade, laparoscopic distal pancreatectomy (LDP) has gained increasing acceptance in the surgical community as a viable treatment option for distal pancreatic lesions. However, the possible complication of post-LDP pancreatic leakage remains a challenge, because it may lead to a series of events resulting in intraperitoneal abscess formation, sepsis, pseudoaneurysm formation, and occasional fatal hemorrhage. Dealing with these complications is extremely difficult and not much experience has been reported to date. We report a case involving the aforementioned post-LDP complications successfully managed by interventional radiological techniques while avoiding reoperation. We conclude that these management options are attractive, safe and minimally invasive alternatives to standard protocols.
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