Gastric bleeding risk following spleen preserving distal pancreatectomy with excision of the splenic vessels: a long-term follow-up

Louis, Damien; Al-Assiri, Abdullah; Kirzin, Sylvain; Blaye-Felice, Sébastien; Rieu, M. Chalret du; Julio, C.H.; Bloom, Éric; Ghouti, Laurent; Pradère, B.; Portier, G.; Carrère, Nicolas

doi:10.1016/j.hpb.2016.12.003

Cited by 17 publications

(12 citation statements)

References 23 publications

(31 reference statements)

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“…17 Patients underwent spleen-preserving total pancreatectomy using the Warshaw operation were evaluated for splenic infarcts and perigastric varices (tortuous veins larger than 5 mm in diameter along the gastric wall) with CT scans. 14,18,19…”

Section: Surgical Technique For Total Pancreatectomy With Preservatmentioning

confidence: 99%

Total pancreatectomy for pancreatic malignancy with preservation of the spleen

Yang

Jin

Warshaw

et al. 2019

Journal of Surgical Oncology

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Background Total pancreatectomy may be necessary to achieve margin‐negative resection for pancreatic cancer. However, despite the desirability of saving the spleen, the feasibility, safety, and oncological outcomes of spleen‐preserving total pancreatectomy have not been studied in patients with malignancy involving the pancreatic neck or proximal body. The aim of this study was to report the efficacy of spleen‐preserving total pancreatectomy using the Warshaw technique for patients with pancreatic malignancies. Methods A retrospective analysis of patients who underwent total pancreatectomy for malignant pancreatic diseases between December 2006 and January 2018 focused on comparing the clinical outcomes between conventional operations with splenectomy and spleen‐preserving total pancreatectomy using the Warshaw technique. Results Thirty‐eight patients among a total of 59 total pancreatectomies had the spleen preservation by the Warshaw operation. In this series, the pancreatic ductal adenocarcinomas resected with the Warshaw technique were of smaller tumor size but had greater rates of vascular invasion, resulting in the more frequent vascular resection. No patients had splenic complications requiring splenectomy, but two patients intended to have the Warshaw operation were converted to splenectomy because of splenic malperfusion. Asymptomatic perigastric varices were noted in 4 patients. Postoperative morbidity and mortality were comparable between the Warshaw and conventional operation groups. Recurrence‐free and overall survival was similar in both groups. Conclusion In patients with pancreatic malignancy, total pancreatectomy with preservation of the spleen using the Warshaw technique achieves outcomes comparable with conventional total pancreatectomy with splenectomy in selected patients.

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Section: Surgical Technique For Total Pancreatectomy With Preservatmentioning

confidence: 99%

Total pancreatectomy for pancreatic malignancy with preservation of the spleen

Yang

Jin

Warshaw

et al. 2019

Journal of Surgical Oncology

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“…40 Second, there are several spleen-related vascular complications that should be prevented, especially following MI-SPDP, such as splenic infarction, 40,43,[45][46][47][48] thrombosis in the preserved SpV, sacrifice of the SpA for the hemostasis of injured DPA, and left-sided portal hypertension with subsequent development of gastric varices. 51,83,101,102 Therefore, it is essential to understand and preserve the possible collateral pathways for spleen perfusion when dividing the SpA and/or SpV. Several reports have shown comparable outcomes, including similar occurrence rates of spleen-related vascular complications, and of MI-SPDP compared to open SPDP 52,103 ; however, further discussion is needed on the types of MI-SPDP surgical approaches that sufficiently account for the anatomical vascular pitfalls and contribute to preserving the collateral pathways of the SpA and SpV.…”

Section: Discussionmentioning

confidence: 99%

Precision vascular anatomy for minimally invasive distal pancreatectomy: A systematic review

Nishino

Zimmitti

Ohtsuka

et al. 2021

J Hepato Biliary Pancreat

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Background Minimally invasive distal pancreatectomy (MIDP) is increasingly performed worldwide; however, the surgical anatomy required to safely perform MIDP has not yet been fully considered. This review evaluated the literature concerning peripancreatic vascular anatomy, which is considered important to conduct safe MIDP. Methods A database search of PubMed and Ichushi (Japanese) was conducted. Qualified studies investigating the anatomical variations of peripancreatic vessels related to MIDP were evaluated using SIGN methodology. Results Of 701 articles yielded by our search strategy, 76 articles were assessed in this systematic review. The important vascular anatomy required to recognize MIDP included the pancreatic parenchymal coverage on the root and the running course of the splenic artery, branching patterns of the splenic artery, confluence positions of the left gastric vein and the inferior mesenteric vein, forms of pancreatic veins including the centro‐inferior pancreatic vein, characteristics of the left renal vein, and collateral routes perfusing the spleen following Warshaw's technique. Very few articles evaluating the relationship between the anatomical variations and surgical outcomes of MIDP were found. Conclusions The precise knowledge of peripancreatic vessels is important to adequately complete MIDP. More detailed anatomic analyses and descriptions will benefit surgeons and their patients who are facing these operations.

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“…While these events might be triggered by perioperative stress, the reported incidence of postoperative upper GI bleed is lower. [17][18][19] Due to the limited number of patients included and the few such events, a definitive conclusion cannot be drawn. However, none of the patients developed any other episode of upper GI bleeding over the course of hospital stay and coagulation disorders were ruled out in patients with such acute bleedings.…”

Section: Early Complicationsmentioning

confidence: 99%

Sternal Reconstruction with the Omental Flap—Acute and Late Complications, Predictors of Mortality, and Quality of Life

Kolbenschlag

Horner

Sogorski

et al. 2018

J reconstr Microsurg

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Gastric bleeding risk following spleen preserving distal pancreatectomy with excision of the splenic vessels: a long-term follow-up

Abstract: Asymptomatic varices frequently occurred in patients who underwent VR-SPDP, but bleeding risk seemed low. Abdominal CT could identify GV and distinguish submucosal varices with a higher risk of gastric bleeding.

Cited by 17 publications

References 23 publications

Total pancreatectomy for pancreatic malignancy with preservation of the spleen

Total pancreatectomy for pancreatic malignancy with preservation of the spleen

Precision vascular anatomy for minimally invasive distal pancreatectomy: A systematic review

Sternal Reconstruction with the Omental Flap—Acute and Late Complications, Predictors of Mortality, and Quality of Life

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