Distal pancreatectomy for benign and low grade malignant tumors: Short‐term postoperative outcomes of spleen preservation—A systematic review and update meta‐analysis

Pendola, Fiorella; Gadde, Rahul; Ripat, Caroline; Sharma, R.; Picado, Omar; Lobo, Laila; Sleeman, Danny; Livingstone, Alan S.; Merchant, Nipun B.; Yakoub, Danny

doi:10.1002/jso.24507

Cited by 35 publications

(28 citation statements)

References 47 publications

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“…However, as the role of the spleen has become better understood over the recent decades, SP-LDP has emerged as a first-choice operation for benign or low-grade malignant tumors located within the body or tail of the pancreas. Several studies showed higher complication rates after distal pancreatectomy with concomitant splenectomy [30][31][32]. In the present study, concomitant splenectomy was associated with more post-LDP complications.…”

Section: Discussionsupporting

confidence: 60%

Predictive Factors Associated with Complications after Laparoscopic Distal Pancreatectomy

Song

Hong

Kim

et al. 2020

JCM

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Although laparoscopic distal pancreatectomy (LDP) has become more popular, the postoperative complication rate remains high. We sought to identify the risk factors for post-LDP complications. We examined 1227 patients who underwent LDP between March 2005 and December 2015 at a single large-volume center. We used logistic regression for the analysis. The overall (13.2%) and major (3.3%) complication rates were determined. Postoperative pancreatic fistula was the most frequent complication, and 58 patients (4.7%) had clinically significant (grade B) pancreatic fistulas. No 90-day mortality was recorded. Long operative time (≥200 min), large estimated blood loss (≥320 mL), LDP performed by an inexperienced surgeon (<50 cases), and concomitant splenectomy were identified as risk factors for overall complications using a logistic regression model. For major complications, male sex (p = 0.020), long operative time (p = 0.005), and LDP performed by an inexperienced surgeon (p = 0.026) were significant predictive factors. Using logistic regression analysis, surgery-related factors, including long operative time and LDP performed by an inexperienced surgeon, were correlated with overall and major complications of LDP. As LDP is a technically challenging procedure, surgery-related variables emerged as the main risk factors for postoperative complications. Appropriate patient selection and sufficient surgeon experience may be essential to reduce the complications of LDP.

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Section: Discussionsupporting

confidence: 60%

Predictive Factors Associated with Complications after Laparoscopic Distal Pancreatectomy

Song

Hong

Kim

et al. 2020

JCM

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“…DP can be performed with splenectomy or with splenic preservation. Several studies have suggested the feasibility and potential benefit of splenic preservation during DP including the preservation of immune function and reduction of the risk of overwhelming post-splenectomy infection, intraoperative blood loss, infections, and other complications related to the splenectomy procedure itself [14,20,21]. A splenic preserving technique has not been endorsed for pancreatic adenocarcinoma to avoid an inadequate oncologic operation [15].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes after Spleen-Preserving Distal Pancreatectomy for Pancreatic Neuroendocrine Tumors: Results from the US Neuroendocrine Study Group

Sahara¹,

Tsilimigras²,

Moro³

et al. 2020

Neuroendocrinology

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Background: The adoption of spleen-preserving distal pancreatectomy (SPDP) for malignant disease such as pancreatic neuroendocrine tumors (pNETs) has been controversial. The objective of the current study was to assess the impact of SPDP on outcomes of patients with pNETs. Methods: Patients undergoing a distal pancreatectomy for pNET between 2002 and 2016 were identified in the US Neuroendocrine Tumor Study Group database. Propensity score matching (PSM) was used to compare short- and long-term outcomes of patients undergoing SPDP versus distal pancreatectomy with splenectomy (DPS). Results: Among 621 patients, 103 patients (16.6%) underwent an SPDP. Patients who underwent SPDP were more likely to have lower BMI (median, 27.5 [IQR 24.0–31.2] vs. 28.7 [IQR 25.7–33.6]; p = 0.005) and have undergone minimally invasive surgery (n = 56, 54.4% vs. n = 185, 35.7%; p < 0.001). After PSM, while the median total number of lymph nodes examined among patients who underwent an SPDP was lower compared with DPS (3 [IQR 1–8] vs. 9 [5–13]; p < 0.001), 5-year overall survival (OS) and recurrence-free survival (RFS) were comparable (OS: 96.8 vs. 92.0%, log-rank p = 0.21, RFS: 91.1 vs. 84.7%, log-rank p = 0.93). In addition, patients undergoing SPDP had less intraoperative blood loss (median, 100 mL [IQR 10–250] vs. 150 mL [IQR 100–400]; p = 0.001), lower incidence of serious complications (n = 13, 12.8% vs. n = 28, 27.5%; p = 0.014), and shorter length of stay (median: 5 days [IQR 4–7] vs. 6 days [IQR 5–13]; p = 0.049) compared with patients undergoing DPS. Conclusion: SPDP for pNET was associated with acceptable perioperative and long-term outcomes that were comparable to DPS. SPDP should be considered for patients with pNET.

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“…The surgical treatment of benign and low-grade malignant tumors in the pancreatic body/tail always has the potential for spleen-preserving distal pancreatectomy (SPDP). SPDP is associated with lower rates of postoperative complications [8][9][10], such as thrombocytosis, embolism, and infection. Splenic vessel-sacrificing (Warshaw technique (WT)) SPDP and splenic vessel-preserving (Kimura technique (KT)) SPDP are two methods applied in SPDP [11,12].…”

Section: Introductionmentioning

confidence: 99%

Robotic-assisted versus open distal pancreatectomy for benign and low-grade malignant pancreatic tumors: a propensity score-matched study

et al. 2020

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Background This study aimed to compare the short-term outcomes of open and robotic-assisted distal pancreatectomy (ODP and RDP) for benign and low-grade malignant tumors. Methods The patients who underwent RDP and ODP for benign or low-grade malignant pancreatic tumors at our center were included. After PSM at a 1:1 ratio, the perioperative variations in the two cohorts were compared. Results After 1:1 PSM, 219 cases of RDP and ODP were recorded. The RDP cohort showed advantages in the operative duration [120 (90-150) min vs 175 (130-210) min, P < 0.001], estimated blood loss [50 (30-175) ml vs 200 (100-300) ml, P < 0.001], spleen preservation rate (63.5% vs 26.5%, P < 0.001), infection rate (4.6% vs 12.3%, P = 0.006), and gastrointestinal function recovery [3 (2-4) vs. 3 (3-5), P = 0.019]. There were no significant differences in postoperative pancreatic fistula, postoperative hemorrhage, and delayed gastric emptying. Multivariate analysis showed that RDP (HR 0.24; 95% CI 0.16-0.36,

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Distal pancreatectomy for benign and low grade malignant tumors: Short‐term postoperative outcomes of spleen preservation—A systematic review and update meta‐analysis

Abstract: 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.

Cited by 35 publications

References 47 publications

Predictive Factors Associated with Complications after Laparoscopic Distal Pancreatectomy

Predictive Factors Associated with Complications after Laparoscopic Distal Pancreatectomy

Long-Term Outcomes after Spleen-Preserving Distal Pancreatectomy for Pancreatic Neuroendocrine Tumors: Results from the US Neuroendocrine Study Group

Robotic-assisted versus open distal pancreatectomy for benign and low-grade malignant pancreatic tumors: a propensity score-matched study

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