Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta‐analysis

Nakata, Kohei; Shikata, Satoru; Ohtsuka, Takao; Ukai, Tomohiko; Miyasaka, Yoshihiro; Mori, Yasuhisa; Velasquez, Vittoria Vanessa; Gotoh, Yoshitaka; Ban, Daisuke; Nakamura, Yoshiharu; Nagakawa, Yuichi; Tanabe, Minoru; Sahara, Yoshinori; Takaori, Kyoichi; Honda, Goro; Misawa, Takeyuki; Kawai, Manabu; Yamaue, Hiroki; Morikawa, Takanori; Kuroki, Tamotsu; Mou, Yiping; Lee, Woo Jung; Shrikhande, Shailesh V.; Tang, Chung Ngai; Conrad, Claudius; Han, Ho‐Seong; Palanivelu, Chinnusamy; Asbun, Horacio J.; Kooby, David A.; Wakabayashi, Go; Takada, Tadahiro; Yamamoto, Masakazu; Nakamura, Masafumi

doi:10.1002/jhbp.569

Cited by 52 publications

(57 citation statements)

References 48 publications

(61 reference statements)

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“…There are many retrospective nonrandomized studies comparing the Warshaw operation, the Kimura technique (splenic vessels preservation), and splenectomy in distal pancreatectomy, 11,13,[45][46][47] but none has been performed about total pancreatectomy. To our knowledge, the present study represents the first observational study of surgical outcomes and survival comparing the Warshaw technique with conventional total pancreatectomy and splenectomy.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study by Nakao et al42 found that compared with pylorus-preserving and subtotal stomach-preserving total pancreatectomies, total pancreatectomy with distal gastrectomy could reduce postoperative gastric venous congestion and bleeding. Therefore, spleen-preserving total pancreatectomy using the Warshaw technique can be considered reasonable and perhaps preferable in selected patients with pancreatic cancers.There are many retrospective nonrandomized studies comparing the Warshaw operation, the Kimura technique (splenic vessels preservation), and splenectomy in distal pancreatectomy,11,13,[45][46][47] but none has been performed about total pancreatectomy. In contrast to the report by Ferrone et al,14 we observed two patients developed splenomegaly and subsequent thrombocytopenia, but neither of them had evidence of bleeding.…”

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confidence: 99%

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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: Discussionmentioning

confidence: 99%

mentioning

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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“…First, we did not discriminate spleen‐vessel preserving LDP from standard LDP with splenectomy. Our systematic review of the literature demonstrated that spleen‐preserving LDP has significantly superior outcomes compared to LDP with splenectomy, and in a spleen‐preserving setting, vessel‐preservation has better outcomes over Warshaw operation (vessel‐resection) in terms of reducing splenic complications . However, many Japanese institutions prefer not to perform spleen‐preserving LDP because of the complexity of the procedure.…”

Section: Discussionmentioning

confidence: 96%

A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients

Ohtsuka

Nagakawa

Toyama

et al. 2019

J Hepato Biliary Pancreat

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Background Prospective studies are needed to understand the safety and feasibility of laparoscopic pancreatectomy. The aim of the present study was to describe laparoscopic pancreatectomy currently undertaken in Japan, using a prospective registration system. Methods Patient characteristics and planned operations were registered preoperatively, and then the performed operation and outcomes were reported using an online system. Collected data were also compared between institutions based on their level of experience. This study was registered with UMIN000022836. Results Available data were obtained from 1,429 patients at 100 Japanese institutions, including 1,197 laparoscopic distal pancreatectomies (LDPs) and 232 laparoscopic pancreatoduodenectomies (LPDs). The rates of completion for planned operations were 92% for LDP and 91% for LPD. Postoperative complication rates after LDP and LPD were 17% and 30%, and 90-day mortality rates were 0.3% and 0.4%, respectively. Shorter operation time, less blood loss, and lower incidence of pancreatic fistula were observed in institutions experienced in LDP. A higher rate of pure laparoscopic procedure and shorter operation time were noted in institutions experienced with LPD. Conclusion LDPs and LPDs are performed safely in Japan, especially in experienced institutions. Our data could support the next challenges in the field of laparoscopic pancreatectomy.

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“…SPDP is beneficial for patients, because it can prevent an increased risk of overwhelming postsplenectomy infection by preserving the splenic immunological function [15]. Laparoscopic surgery is desirable not only because it is minimally invasive, but also because it favors spleen preservation due to a magnified laparoscopic view, which allows for safe dissection of the small pancreatic vessels [16].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic spleen-preserving distal pancreatectomy for a solid-cystic intraabdominal desmoid tumor at a gastro-pancreatic lesion: a case report

et al. 2020

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Background: We report a case of an intraabdominal desmoid tumor that occurred at a gastro-pancreatic lesion with spontaneous cystic features, and present the successful laparoscopic resection of the tumor. Case presentation: A 20-mm retroperitoneal cystic mass with a solid component was found adjacent to the stomach and pancreatic body in a 52-year-old woman with no history of familial adenomatous polyposis. Laparoscopic spleen-preserving distal pancreatectomy with wedge resection of the stomach was performed, and complete resection was achieved without intraoperative and postoperative complications. Histopathological examination by immunohistochemistry enabled diagnosis of a desmoid tumor that had originated from the stomach and invaded the pancreatic parenchyma with a spontaneous cystic change. We herein report an extremely rare case of an intraabdominal desmoid tumor with a spontaneous cystic change. Conclusion: Regardless of its rarity, desmoid tumor should be included in the preoperative differential diagnosis of a cystic intraabdominal mass, and laparoscopic function-preserving surgery may be an optimal treatment option.

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Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta‐analysis

Abstract: Based on this study, SPDP has significantly superior outcomes compared to DPS. When a spleen is preserved, SVP has better outcomes over WT for reducing splenic complications.

Cited by 52 publications

References 48 publications

Total pancreatectomy for pancreatic malignancy with preservation of the spleen

Total pancreatectomy for pancreatic malignancy with preservation of the spleen

A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients

Laparoscopic spleen-preserving distal pancreatectomy for a solid-cystic intraabdominal desmoid tumor at a gastro-pancreatic lesion: a case report

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