Spleen-preserving<i>versus</i>spleen-sacrificing distal pancreatectomy in adults with blunt major pancreatic injury

Lin, Being-Chuan; Chen, R.-J.; Hwang, Tsann‐Long

doi:10.1002/bjs5.89

Cited by 10 publications

(12 citation statements)

References 24 publications

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“…Ten studies investigated the impact of splenectomy on CR-POPF rate in 3602 patients. 2,4,15,16,19,31,32,35,48,54 There was no difference in CR-POPF rate between splenectomy group (19.3%, 548/2834) and spleen-preserving group (18.5%, 142/768) (OR 0.99, 95%-CI: 0.64-1.53, p = 0.97, Fig. 3c).…”

Section: Splenectomy Versus Spleen-preservingmentioning

confidence: 88%

“…Thirty-four studies were retrospective cohort studies, 2,4,14-45 three were prospective cohort studies, [46][47][48] two were randomized-controlled trials, 49,50 two were propensity matched studies (retrospective 51 and prospective 52 ), one was a retrospective matched-pair analysis, 53 and one was a case-control study. 54 performed in Japan (n = 14), 15,21,24,25,30,31,33,34,39,42,43,45,48,54 USA (n = 6), 14,17,26,35,47,51 Italy (n = 5), 20,22,27,46,52 China (n = 5), 4,32,36,38,44 Germany (n = 3), 23,40,53 Korea (n = 2), 29,36 Finland (n = 2), 37,49 France (n = 1), 28 Taiwan (n = 1), 16 Sweden (n = 1), …”

Section: Study Characteristicsmentioning

confidence: 99%

“…2,4, The weighted incidence of POPF B and C were 20.2% (95%-CI: 16.9-24.0%) and 1.6% (95%-CI: 1.2-2.2%), respectively. 2,4,16,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][37][38][39][40][41][44][45][46][49][50][51][52][53][54] Meta-analysis of risk factors…”

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review and meta-analysis of risk factors of postoperative pancreatic fistula after distal pancreatectomy in the era of 2016 International Study Group pancreatic fistula definition

Chong

Ratnayake

Lee

et al. 2021

HPB

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Section: Splenectomy Versus Spleen-preservingmentioning

confidence: 88%

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review and meta-analysis of risk factors of postoperative pancreatic fistula after distal pancreatectomy in the era of 2016 International Study Group pancreatic fistula definition

Chong

Ratnayake

Lee

et al. 2021

HPB

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“…The time interval from injury to surgery was a significant associated factor in preserving or sacrificing the spleen. As time passes by, the continuously spreading inflammation and autodigestion impair the technical approach making vascular dissection and ligation difficult with resultant spleen sacrifice when performing distal pancreatectomy [26]. Limitations of this report include a rather long study period and the relatively small sample size (25 patients underwent distal pancreatectomy in 22 years).…”

Section: Discussionmentioning

confidence: 94%

Lessons learned from isolated blunt major pancreatic injury: Surgical experience in one trauma centre

Lin

Chen

Hwang

2019

Injury

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The aim of this study was to present our surgical experience of isolated blunt major pancreatic injury (IBMPI), and to compare its characteristic outcomes with that of multi-organ injury. Materials and methods: From 1994-2015, 31 patients with IBMPI and 54 patients with multi-organ injury, who underwent surgery, were retrospectively studied. Results: Of the 31 patients with IBMPI, 22 were male and 9 were female. The median age was 30 years (interquartile range, 20-38). Twenty-one patients were classified as the American Association for the Surgery of Trauma-Organ Injury Scale Grade III, and 10 patients as Grade IV. Patients with IBMPI had significantly lower shock-at-triage rates, lower injury severity scores, longer injury-to-surgery time, and shorter length of hospital stay than those with multi-organ injury. There were no statistically significant differences in sex, age, trauma mechanism, laboratory data, surgical procedures, and complications between the two groups. Eight patients with IBMPI underwent endoscopic retrograde pancreatography, and 5 patients with complete major pancreatic duct (MPD) disruption underwent pancreatectomy eventually. The remaining 3 patients had partial MPD injury and two of them received a pancreatic duct stent for the treatment of existing postoperative pancreatic fistula. Spleen-sacrificing distal pancreatectomy (SSDP) was performed in 13 patient with IBMPI, followed by spleen-preserving distal pancreatectomy (n = 12), peripancreatic drainage (n = 4), and central pancreatectomy with Rouxen-Y reconstruction (n = 2). The overall complication rates, related to the SSDP, SPDP, peripancreatic drainage, and central pancreatectomy, were 10/13 (77%), 4/12 (33%), 3/4 (75%), and 2/2 (100%), respectively. Three patients died resulting in a 10% mortality rate, and the other 16 patients developed intra-abdominal complications resulting in a 52% morbidity rate. In the subgroup analysis of the 25 patients who underwent distal pancreatectomy, SPDP was associated with a shorter injury-to-surgery time than SSDP. Conclusions: Patients with IBMPI have longer injury-to-surgery times, compared to those with multiorgan injury. Of the distal pancreatectomy patients, the time interval from injury to surgery was a significant associated factor in preserving or sacrificing the spleen.

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“…For deep injury with ductal injury (AAST-OIS grade III and IV and JAST type IIIb), resection of the injured part of the pancreas is recommended [4], [17], [18] . Conservative nonsurgical management of severe pancreatic trauma was recently reported in several studies [1], [5], [19], [20] .…”

Section: Discussion and Proposal For Algorithm For Management Of Pancmentioning

confidence: 99%

Pancreatic Trauma: Proposal for Management Algorithm

Hashimoto

Yamamoto

Yamaki

et al. 2020

International Surgery

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IntroductionPancreatic trauma is potentially lethal despite recent improvements in surgical techniques and conservative management. However, no guidelines for the management of pancreatic trauma have been established. In this report, we propose an algorithm for the management of pancreatic trauma based on our experience of nine cases and a literature review.Case presentationThis study included nine patients with pancreatic trauma (five men and four women). The patients’ median age was 40 years (range, 17–75 years). The overall mortality rate was 22.2%, and the postoperative mortality rate was 16.7%. Superficial trauma was present in two patients. Deep trauma without injury to the main pancreatic duct was present in one patient, and this patient was treated successfully with endoscopic nasopancreatic drainage. Active bleeding was present in two patients and controlled by interventional radiology. Deep trauma with injury to the main pancreatic duct was present in six patients. Among them, one patient died after conservative treatment with endoscopic nasopancreatic drainage. The other five patients underwent surgery (pancreatic resection in four and necrosectomy in one).ConclusionThe herein-described algorithm recommends interventional radiology for active arterial bleeding, conservative management for trauma without ductal injury, and surgery for trauma with ductal injury. This algorithm may provide a basis for future establishment of guidelines.

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Spleen-preservingversusspleen-sacrificing distal pancreatectomy in adults with blunt major pancreatic injury

Cited by 10 publications

References 24 publications

Systematic review and meta-analysis of risk factors of postoperative pancreatic fistula after distal pancreatectomy in the era of 2016 International Study Group pancreatic fistula definition

Systematic review and meta-analysis of risk factors of postoperative pancreatic fistula after distal pancreatectomy in the era of 2016 International Study Group pancreatic fistula definition

Lessons learned from isolated blunt major pancreatic injury: Surgical experience in one trauma centre

Pancreatic Trauma: Proposal for Management Algorithm

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