Clinical Comparison of Distal Pancreatectomy with or without Splenectomy: A Meta-Analysis

Abstract

ObjectiveA 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.MethodsA 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.ResultsEleven 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.ConclusionSPDP 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.

Splenic preservation in laparoscopic distal pancreatectomy

“…Concomitant splenectomy is associated with increased rates of infection 28 , greater morbidity 29 and poorer cancer survival 29 -32 . In the context of distal pancreatectomy, the present study suggested that patients undergoing LSPDP had lower overall morbidity, lower abdominal abscess rates and lower in-hospital costs than those undergoing LDPS, although some differences were not statistically significant. The trends in overall morbidity and abdominal abscess in this study were similar to the findings in previous meta-analyses 33,34 .…”

Total pancreatectomy for pancreatic malignancy with preservation of the spleen

“…8 Splenectomy may increase the incidence of postoperative infectious complications and the potential risk of developing malignancy later. 11,12 The conventional means of saving the spleen involves dissection of the splenic artery and vein out of the pancreatic body and tail. 11,12 The conventional means of saving the spleen involves dissection of the splenic artery and vein out of the pancreatic body and tail.…”

Incidental Splenic Injury and Splenectomy: An Overview Based on Available Evidence

“…Thirty-nine articles in extensive were discarded for failing to meet the eligibility criteria. Finally, the population in study consisted of 35 articles, 3 of evidence level type 3a (Renzulli et al, 2009;He et al, 2014;Piccolo et al, 2014), 32 of evidence level type 4 (Bagrodia et al, 2014;Barmparas et al, 2015;Bracale et al, 2013;Cassar & Munro, 2009;Coon, 1990;Chung et al, 2011;Davies et al, 2014;Eaton et al, 2000;Eber et al, 1999;Edgren et al, 2014;Flum et al, 2001;Geraci et al, 2014;Gómez Alonso et al, 2001;Ha & Minchin, 2009;Harbrecht et al, 2008;Holubar et al, 2009;Kamath et al, 2009;Malek et al, 2007;Masoomi et al, 2012;McIntyre et al, 2005;Merchea et al, 2012;Nikolaev et al, 1990;Ong et al, 1991;Paredes et al, 2013;Rogers et al, 1980;Singla, et al, 2012;Tan et al, 2011;Urschel, 1993;Wang et al, 2011;Yong et al, 2010; and 1 of evidence level type 5 (American Society for Metabolic & Bariatric Surgery, 2012).…”

“…The overall standardized incidence ratios for hospitalization for sepsis in a retrospective cohort study of all patients in the Swedish national inpatient register (N = 20,132) was 5.7 [95 % CI 5.6-6.0] (Evidence level type 4) (Edgren et al, 2014). On the other hand, in a systematic review based on MEDLINE, EMBASE and Cochrane Library performed to evaluate and compare the clinical outcomes between spleen-preserving distal pancreatectomy and distal pancreatectomy with splenectomy, that included 11 non-randomized controlled studies (N=897 patients), spleen-preserving had a lower incidence of intra-abdominal abscesses (OR=0.48, 95 % CI=0.27, 0.83), but there were no differences respect to operative blood loss, requirement for blood transfusion, postoperative bleeding, wound infections and re-operation rates (Evidence level type 3a) (He et al, 2014). In a retrospective study of patients who were scheduled to receive laparoscopic surgery for distal pancreatic lesions spleen-preserving distal pancreatectomy and distal pancreatectomy with splenectomy were compared in terms of POM, and no significant differences were reported in complications and POM rates between the two groups (Evidence level type 4) .…”